This results in thrombotic events in up to one-third of patients with COVID-19 ( 4). Early COVID-19 is mostly associated with a prothrombotic state promoted among others by endothelial inflammation and dysfunction with consecutive release of prothrombotic factors and exposure of collagen and tissue factor ( 1– 3). It poses considerable diagnostic and therapeutic challenges because of the often differing and rapidly changing hemostaseological conditions. In patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced acute respiratory distress syndrome (ARDS) undergoing venovenous extracorporeal membrane oxygenation (vvECMO), safe and effective management of coagulation is a crucial part of the overall medical care. Desmopressin did not affect vWF parameters. During vvECMO, decreases in the vWF:A/vWF:Ag ratio correlated with absent HMW vWF multimers. All variables fully recovered within 3–38 hours after discontinuation of vvECMO. Following markedly elevated vwf antigen (vWF: Ag mean, 546% ( sd, 282]), vWF collagen binding capacity (mean, 469% ), vWF activity (vWF:A mean, 383% ), and factor VIII activity (mean, 302% ), and only borderline decreases in high-molecular-weight (HMW) vWF multimers before vvECMO, all of these variables decreased and HMW vWF multimers became undetectable within hours following initiation of vvECMO. The patients’ mean age was 53 years (range, 23–73), 70% were male, and all had various comorbidities. In a subgroup of 12 patients with AVWS, effectiveness of treatment with desmopressin was assessed.

Comprehensive vWF analyses (including sodium dodecyl-sulfate polyacrylamide gel electrophoresis) were performed before, during, and after vvECMO.

Ag ratio normal range