Platelet activation is a preoperative risk factor for the development of thromboembolic complications in patients with continuous-flow left ventricular assist device
| Autor: | Patrizia Della Valle, Rosalba Lembo, Loris Pozzi, Giulia Motolone, Alberto Redaelli, Marvin J. Slepian, Federico Pappalardo, Lorenzo Valerio, Michele De Bonis, Alberto Zangrillo, Giulia Sferrazza, Filippo Consolo, Rachele Contri, Gianfranco Beniamino Fiore |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
education.field_of_study business.industry medicine.medical_treatment 0206 medical engineering Population 02 engineering and technology 030204 cardiovascular system & hematology medicine.disease 020601 biomedical engineering 03 medical and health sciences 0302 clinical medicine Coagulation Ventricular assist device Internal medicine Heart failure Antithrombotic medicine Cardiology Medical history Platelet activation Cardiology and Cardiovascular Medicine Adverse effect education business |
| Zdroj: | European Journal of Heart Failure. 20:792-800 |
| ISSN: | 1388-9842 |
| DOI: | 10.1002/ejhf.1113 |
| Popis: | Aims To correlate the dynamics of platelet activation with the development of thromboembolic events in patients with continuous-flow left ventricular assist device (cf-LVAD). Methods and results The platelet activity state (PAS) assay was utilized to evaluate platelet activation in 68 cf-LVAD patients implanted with the HeartMate II (n = 15, 22%), HeartMate 3 (n = 15, 22%), or HeartWare HVAD (n = 38, 56%). PAS was measured preoperatively, early post-implant, and at long-term follow-up (1, 3, 6, 12, 18, and 24 months post-implant). PAS was also measured at the occurrence of adverse events in patients who developed thrombotic complications. Data on patient demographics, medical history, antithrombotic therapy, and coagulation parameters were also analysed. Over a median follow-up of 602 (234-942) days, PAS values did not increase over time in the overall population (P = 0.15). However, PAS measured at event was 15-fold higher in the six patients (9%) who suffered pump thrombosis (n = 2) or ischaemic stroke (n = 4) vs. the rest of the population [6.67% (5.59%-11.98%) vs. 0.45% (0.33%-0.75%); P = 0.012], despite comparable coagulation profile. Pre-implant PAS values were 4.5-fold higher in these patients [1.90% (1.24%-3.17%) vs. 0.42% (0.32%-0.72%); P = 0.006]. Neither preoperative variables nor the type of the pump or the antiplatelet strategy were associated with a higher risk of complications. Conclusions Thrombotic events are associated with altered PAS values. Moreover, baseline elevated PAS values in patients who developed thrombotic events suggest patient-specific tendency to post-implant thromboembolic complications. Prospectively, systematic monitoring of PAS might guide the development of refined patient-tailored antithrombotic strategies and the technological improvement of LVAD design. |
| Databáze: | OpenAIRE |
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