Bleeding in patients with continuous-flow left ventricular assist devices: acquired von Willebrand disease or antithrombotics?
| Autor: | Marina Pieri, Alberto Redaelli, Armando D'Angelo, Filippo Consolo, Anna Mara Scandroglio, Patrizia Della Valle, Federico Pappalardo, Alessandra Marasi, Marta Bonora, Alberto Zangrillo |
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| Přispěvatelé: | Consolo, Filippo, Marasi, Alessandra, Della Valle, Patrizia, Bonora, Marta, Pieri, Marina, Scandroglio, Anna Mara, Redaelli, Alberto, Zangrillo, Alberto, D'Angelo, Armando, Pappalardo, Federico |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Left ventricular assist device Hemorrhage Von Willebrand factor Fibrinolytic Agents Internal medicine von Willebrand Factor Antithrombotic medicine Von Willebrand disease Humans In patient Pathological Antithrombotic therapy Aspirin biology business.industry Bleeding General Medicine medicine.disease Discontinuation von Willebrand Diseases Regimen Cardiology biology.protein Surgery Warfarin Heart-Assist Devices Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | European Journal of Cardio-Thoracic Surgery. 62 |
| ISSN: | 1873-734X 1010-7940 |
| DOI: | 10.1093/ejcts/ezab474 |
| Popis: | OBJECTIVES To evaluate the competing pro-haemorrhagic contribution of acquired von Willebrand (vW) disease and antithrombotic therapy in patients implanted with continuous-flow left ventricular assist devices (LVADs). METHODS We compared the extent of vW factor (vWf) degradation [vWf antigen (vWf:Ag)] and a decrease of functional activity of large vWf multimers [vWf collagen binding (vWf:CB)] in LVAD patients who did and did not suffer from bleeding. Data were measured pre-implant, at short-term (t1: 12 months) follow-up. The occurrence of primary bleeding events, as well as bleeding recurrence, was correlated with patient-specific vWf profile and antithrombotic regimen. Indeed, patients were discharged on warfarin (international normalized ratio: 2–2.5) and aspirin, with the latter withhold after a first bleeding episode. RESULTS Fifty-three patients were enrolled. The median follow-up was 324 (226–468) days. We recorded 25 primary bleeding events (47% of patients). All primary events occurred in patients on warfarin and aspirin. Both vWf:Ag and vWf:CB decreased significantly post-implant (P = 0.0003 and P < 0.0001), and patients showing pathological vWf:CB/vWf:Ag ratio ( CONCLUSIONS Aspirin contributes significantly to haemorrhagic events in the background of acquired vW disease; its discontinuation significantly reduces bleeding recurrence. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03255928; ClinicalTrials.gov Identifier: NCT03255928. |
| Databáze: | OpenAIRE |
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