Factors XI and XII in extracorporeal membrane oxygenation: longitudinal profile in children

Joppe Drop, Natasha Letunica, Suelyn Van Den Helm, C. Heleen van Ommen, Enno Wildschut, Matthijs de Hoog, Joost van Rosmalen, Rebecca Barton, Hui Ping Yaw, Fiona Newall, Stephen B. Horton, Roberto Chiletti, Amy Johansen, Derek Best, Joanne McKittrick, Warwick Butt, Yves d'Udekem, Graeme MacLaren, Matthew D. Linden, Vera IgnjatovicChantal Attard, Paul Monagle

Research output: Contribution to journalArticlepeer-review


Background: Extracorporeal membrane oxygenation (ECMO) is used in children with cardiopulmonary failure. While the majority of ECMO centers use unfractionated heparin, other anticoagulants, including factor XI and factor XII inhibitors are emerging, which may prove suitable for ECMO patients. However, before these anticoagulants can be applied in these patients, baseline data of FXI and FXII changes need to be acquired. Objectives: This study aimed to describe the longitudinal profile of FXI and FXII antigenic levels and function before, during, and after ECMO in children. Methods: This is a prospective observational study in neonatal and pediatric patients with ECMO (<18 years). All patients with venoarterial ECMO and with sufficient plasma volume collected before ECMO, on day 1 and day 3, and 24 hours postdecannulation were included. Antigenic levels and functional activity of FXI and FXII were determined in these samples. Longitudinal profiles of these values were created using a linear mixed model. Results: Sixteen patients were included in this study. Mean FXI and FXII antigenic levels (U/mL) changed from 7.9 and 53.2 before ECMO to 6.0 and 34.5 on day 3 and they recovered to 8.8 and 39.4, respectively, after stopping ECMO. Function (%) of FXI and FXII decreased from 59.1 and 59.0 to 49.0 and 50.7 on day 3 and recovered to 66.0 and 54.4, respectively. Conclusion: This study provides the first insights into changes of the contact pathway in children undergoing ECMO. FXI and FXII antigen and function change during ECMO. Results from this study can be used as starting point for future contact pathway anticoagulant studies in pediatric patients with ECMO.

Original languageEnglish
Article number102252
Number of pages6
JournalResearch and Practice in Thrombosis and Haemostasis
Issue number8
Publication statusPublished - Nov 2023


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