The relationships between disseminated intravascular coagulation and time series change of von Willebrand factor in patients with out-of-hospital cardiac arrest: a retrospective observational study

Background Out-of-hospital cardiac arrest (OHCA) is frequently complicated by disseminated intravascular coagulation (DIC), which is associated with poor outcomes. The von Willebrand factor (VWF) plays a central role in haemostasis, and its multimeric size and activity are regulated by ADAMTS13. In thrombotic thrombocytopenic purpura, decreased ADAMTS13 activity leads to the accumulation of ultralarge VWF multimers and microvascular thrombosis. Elevated VWF antigen (VWF Ag) levels and reduced ADAMTS13 activity have also been observed after OHCAand are correlated with poor outcomes. However, the relationships among VWF activity, VWF multimer size, and ADAMTS13 activity in DIC after OHCA remain unclear. Methods This single-centre retrospective cohort study included adult patients with witnessed cardiogenic OHCA admitted to the Hokkaido University Hospital between September 2019 and January 2023. Patients treated with extracorporeal membrane oxygenation were excluded. Plasma samples were collected from day 0 (upon arrival at the emergency department) to Day4. Plasma VWF antigen (VWF Ag), VWF ristocetin cofactor activity (VWF RCo), VWF large multimer index (VWF LMI), and ADAMTS13 activity were measured, and patients were classified into DIC and non-DIC groups. Temporal changes in these biomarkers were compared between the two groups, and their associations with DIC scores were assessed. Results Among 28 patients with witnessed cardiogenic OHCA, 16 fulfilled the DIC criteria upon admission. VWF-Ag and VWF-RCo were markedly elevated in both groups upon arrival at the emergency department and increased further during the observational period, without significant group differences. The VWF RCo/vWF Ag ratio was decreased in the DIC group. VWF LMI tended to be lower, and ADAMTS13 activity was consistently reduced in the DIC group compared to the non-DIC group. As the DIC score increased, VWF Ag content also increased. Furthermore, the VWF LMI and ADAMTS13 activity decreased as the DIC score increased. Conclusion In patients with OHCA, VWF antigen levels and functional activity are markedly elevated immediately after cardiac arrest. However, despite reduced ADAMTS13 activity in patients with DIC, the VWF multimer size and functional activity did not differ between the DIC and non-DIC groups. Therefore, VWF does not play a major role in platelet activation and DIC pathogenesis in this context and may be cleaved through alternative pathways independent of ADAMTS13. Trial Registration Retrospectively registered.