Acquired von Willebrand Syndrome in Patients With Ventricular Assist Device

Rauch, Antoine; Susen, Sophie; Zieger, Barbara

doi:10.3389/fmed.2019.00007

Cited by 28 publications

(28 citation statements)

References 79 publications

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“…Premature degradation of vWF multimers during MCS and resultant quantitative and functional vWF deficiency have been long recognized as major contributors to pathophysiology of device-related bleeding complications. 21 , 22 Thus, we examined the effect of the Impella 5.5 and Centrimag on plasma concentration of vWF antigen (vWF:Ag), as well as its collagen binding (vWF:CBA), indicating quantity and functional activity of the vWF pool. We showed that within 4 hours of blood recirculation in device-propelled circulatory loops neither Impella 5.5 nor Centrimag resulted in a significant decrease of plasma vWF:Ag ( Figure 6 A ).…”

Section: Resultsmentioning

confidence: 99%

“…Along with the shear-compromised platelet count and function, acquired deficiency of vWF is another well-recognized contributor to the etiology of MCS-related bleeding complications. 21 , 22 , 34 Therefore, we have analyzed the effect of shear stress generated by the Impella 5.5 and Centrimag on plasma levels of vWF:Ag and its collagen binding as indicators of intact vWF structure and function. We observed no significant decrease of vWF antigen concentration over the shear exposure time, rather a slight increase of vWF was noted at 180 minutes of recirculation for Centrimag.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impella 5.5 Versus Centrimag: A Head-to-Head Comparison of Device Hemocompatibility

Roka‐Moiia

Ivich

et al. 2020

ASAIO Journal

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impella 5.5 Versus Centrimag: A Head-to-Head Comparison of Device Hemocompatibility

Roka‐Moiia

Ivich

et al. 2020

ASAIO Journal

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“…Laboratory evaluation of VWF multimers consists of agarose gel electrophoresis, which shows a loss of the large multimers. 69 Also, a reduced binding of VWF to collagen (measured by VWF:collagen binding [CB] activity) is present as is a reduced VWF:CB/VWF:Ag ratio. 49,70 The reduced VWF:RCo activity is already observed early in the postoperative period after LVAD implantation.…”

Section: Gi Bleedingmentioning

confidence: 99%

Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management

Leebeek¹,

Muslem

2019

Hematology

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Chronic heart failure (HF) is a growing health problem, and it is associated with high morbidity and mortality. Left ventricular assist devices (LVADs) are nowadays an important treatment option for patients with end-stage HF not only as a bridging tool to heart transplantation but also, as a permanent therapy for end-stage HF (destination therapy). The use of LVAD is associated with a high risk for bleeding complications and thromboembolic events, including pump thrombosis and ischemic stroke. Bleeding is the most frequent complication, occurring in 30% to 60% of patients, both early and late after LVAD implantation. Although the design of LVADs has improved over time, bleeding complications are still the most common complication and occur very frequently. The introduction of an LVAD results in an altered hemostatic balance as a consequence of blood-pump interactions, changes in hemodynamics, acquired coagulation abnormalities, and the strict need for long-term anticoagulant treatment with oral anticoagulants and antiplatelet therapy. LVAD patients may experience an acquired coagulopathy, including platelet dysfunction and impaired von Willebrand factor activity, resulting in acquired von Willebrand syndrome. In this educational manuscript, the epidemiology, etiology, and pathophysiology of bleeding in patients with LVAD will be discussed. Because hematologist are frequently consulted in cases of bleeding problems in these individuals in a critical care setting, the observed type of bleeding complications and management strategies to treat bleeding are also reviewed.

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“…Some studies in the field have linked PAH with acquired von Willebrand syndrome [ 27 , 28 ]. VWF multimers are particularly large in size, making them vulnerable to biophysical forces, including shear stress [ 29 ]. The increased shear stress of the pulmonary vasculature in PAH can lead to conformational changes of the VWF multimers, which can result in acquired von Willebrand syndrome and, therefore, in reduced VWF:Ac and vWF Ac/Ag ratio [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Coagulation Profiles of Pulmonary Arterial Hypertension Patients, Assessed by Non-Conventional Hemostatic Tests and Markers of Platelet Activation and Endothelial Dysfunction

et al. 2020

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Many pathophysiologic processes of pulmonary arterial hypertension (PAH), namely, excess vasoconstriction, vascular remodeling and in situ thrombosis, involve the coagulation cascade, and more specifically, platelets. The aim of this study was to globally assess coagulation processes in PAH, by using non-conventional hemostatic tests, along with markers of platelet activation and endothelial dysfunction. We studied 44 new PAH patients (22 with idiopathic PAH and 22 with connective tissue disease) and 25 healthy controls. The following tests were performed: platelet function analyzer-100 (PFA-100), light transmission aggregometry (LTA), rotational thromboelastometry (ROTEM), endogenous thrombin potential (ETP), serotonin, thromboxane A2 and p-selectin plasma levels, and von Willebrand antigen (VWF:Ag) and activity (VWF:Ac). Our results showed that PAH patients had diminished platelet aggregation, presence of disaggregation, defective initiation of the clotting process and clot propagation, and diminished thrombin formation capacity. Serotonin, thromboxane A2 and p-selectin levels were increased, and VWF:Ag and VWF:Ac decreased in the same population. The results of this study suggest that the platelets of PAH patients are activated and present functional abnormalities. The procoagulant activity, in general, appears to be impaired probably due to a sustained and prolonged activation of the procoagulant processes. Larger observational studies are warranted to confirm these laboratory findings.

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Acquired von Willebrand Syndrome in Patients With Ventricular Assist Device

Cited by 28 publications

References 79 publications

Impella 5.5 Versus Centrimag: A Head-to-Head Comparison of Device Hemocompatibility

Impella 5.5 Versus Centrimag: A Head-to-Head Comparison of Device Hemocompatibility

Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management

Coagulation Profiles of Pulmonary Arterial Hypertension Patients, Assessed by Non-Conventional Hemostatic Tests and Markers of Platelet Activation and Endothelial Dysfunction

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