ECMO decannulation is associated with dynamic changes in coagulation profiles: an exploratory, nested cohort study

ECMO-associated coagulopathy is a common phenomenon in patients undergoing ECMO therapy. However, data on coagulation trajectories in the post ECMO decannulation period are limited. This study aimed to explore changes in coagulatory function within 72 h after weaning of ECMO therapy. Exploratory, nested cohort study of a prospective, observational, single-centre cohort study investigating haemostatic changes in adult patients undergoing ECMO therapy at a tertiary academic centre and ECMO referral facility in Linz/Austria. Coagulation tests as well as ROTEM® analyses were performed at the time of ECMO decannulation (d0) and three days later (d3). Intra-individual changes in coagulation parameters and viscoelastic test results after weaning of ECMO therapy were determined using paired comparisons (Student’s t-tests or Wilcoxon signed-rank tests) between the two timepoints. 30 adult patients were included into the final analysis. Platelet counts [97 (82–149) vs. 211 (161–346) G/L, p < 0.001)], Factor VIII activity [294 (208–427) vs. 400 (304–450) %, p = 0.03] and Factor XIII activity [63 (52–73) vs. 86 (70–96) %, p < 0.001] increased significantly between d0 and d3. Fibrinogen levels trended upwards after decannulation [601 (419–711) vs. 650 (495–790) mg/dL, p = 0.08]. Antithrombin activity [96 (83–117) vs. 111 (93–130) %, p = 0.001], Protein C [83 (69–99) vs. 93 (90–104) %, p = 0.01] and Protein S activity [78 (60–91) vs. 80 (72–103), p = 0.002] significantly increased between the two timepoints. D-Dimer levels significantly declined between d0 and d3 [13.5 [6–29] vs. 8.1 (3.9–17.3) %, p = 0.019]. ROTEM® analyses showed significant decreases in INTEM® coagulation time and clot formation time, and significant increases in clot amplitude at five and ten minutes, as well as maximum clot firmness in the INTEM® and EXTEM® assays between d0 and d3. Extensive changes in coagulation profiles were observed within 72 hours following ECMO weaning and decannulation. These changes reflect a rapid restoration of haemostasis and possibly an early shift towards a prothrombotic phenotype.