Work

High prevalence of factor XIII deficiency and its association with bleeding in extracorporeal membrane oxygenation patients: an observational study from a prospectively compiled biobank

Year: 2025

Type: article

Abstract: Background Coagulopathy is a major cause of death during extracorporeal membrane oxygenation (ECMO). Factor XIII (FXIII) may play an important role in bleeding risk and represents a potential target for future therapies. Methods This observational study investigated FXIII activity in adult ECMO patients using prospectively collected blood samples. Primary outcomes were the prevalence of FXIII deficiency (<70%). Secondary outcomes included the incidence of bleeding complications according to the BARC classification. Regression models were used to analyze risk factors for FXIII deficiency and its association with bleeding. Results Between March 2020 and September 2023, FXIII activity was assessed in 101 ECMO patients undergoing a total of 108 ECMO runs. FXIII deficiency was identified in 73.3% (n=74) of patients and occurred more frequently in those with viral infections, prolonged ECMO duration, and venovenous ECMO support. Bleeding complications were more frequent in patients with FXIII deficiency (41.9% vs. 11.1%, p=0.003) and the median FXIII activity was significantly associated with bleeding complications (OR 0.97 per 1% increase in activity, CI 0.94 - 0.99, p=0.003). Similarly, minimum FXIII activity was independently associated with bleeding risk (OR 0.967, CI 0.93 – 0.99, p=0.042). Conclusions In this cohort of adult ECMO patients, we observered a high prevalence of FXIII deficiency. FXIII deficiency was common in adult ECMO patients and associated with viral infections, VV ECMO, longer ECMO duration, and bleeding; its therapeutic potential warrants further study.

Source: Research and Practice in Thrombosis and Haemostasis

DOI: 10.1016/j.rpth.2025.103254