Acquired von Willebrand Syndrome in Continuous-Flow Ventricular Assist Device Recipients

Crow, Sheri; Chen, Dong; Milano, Carmelo A.; Thomas, William; Joyce, Lyle D.; Piacentino, Valentino; Sharma, Riti; Wu, Jaclyn; Arepally, Gowthami M.; Bowles, Dawn E.; Rogers, Joseph G.; Villamizar-Ortiz, Nestor

doi:10.1016/j.athoracsur.2010.04.099

Cited by 336 publications

(222 citation statements)

References 17 publications

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“…In addition, bleeding events occurred even in the absence of supratherapeutic anticoagulation, 30,32 a fact also seen in our study where 82% of the patients with bleeding had an INR within the desired therapeutic range. Other factors have been implicated in the increased incidence of bleeding in CF-LVADs, including the development of acquired von Willebrand syndrome, 14,16,17,33,34 impairment in platelet aggregation, 15 and the lack of pulsatility. The potential role of the first 2 factors in the bleeding diathesis observed in patients with CF-LVADs has been investigated; however, the role of pulsatility in this setting is less clear.…”

Section: Discussionmentioning

confidence: 99%

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Wever-Pinzon

Selzman

Drakos

et al. 2013

Circ: Heart Failure

214

111

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Background— Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding. Methods and Results— The Utah Transplantation Affiliated Hospitals (U.T.A.H.) heart failure and transplant program databases were queried for patients with end-stage heart failure who required support with the continuous-flow LVAD HeartMate II (Thoratec Corp, Pleasanton, CA) between 2004 and 2012. Pulsatility was evaluated by means of the LVAD parameter pulsatility index (PI) and by the echocardiographic assessment of aortic valve opening during the first 3 months of LVAD support. PI was analyzed as a continuous variable and also stratified according to tertiles of all the PI measurements during the study period (low PI: <4.6, intermediate PI: 4.6–5.2, and high PI: >5.2). Major nonsurgical bleeding associated with a decrease in hemoglobin ≥2 g/dL (in the absence of hemolysis) was the primary end point. A total of 134 patients (median age of 60 [interquartile range: 49–68] years, 78% men) were included. Major bleeding occurred in 33 (25%) patients (70% gastrointestinal, 21% epistaxis, 3% genitourinary, and 6% intracranial). In multivariable analysis, PI examined either as a categorical variable, low versus high PI (hazard ratio, 4.06; 95% confidence interval, 1.35–12.21; P =0.04), or as a continuous variable (hazard ratio, 0.60; 95% confidence interval, 0.40–0.92; P =0.02) was associated with an increased risk of bleeding. Conclusions— Reduced pulsatility in patients supported with the continuous-flow LVAD HeartMate II is associated with an increased risk of nonsurgical bleeding, as evaluated by PI.

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Section: Discussionmentioning

confidence: 99%

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Wever-Pinzon

Selzman

Drakos

et al. 2013

Circ: Heart Failure

214

111

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“…The frequency of bleeding in these patients, however, was not related to the level of vWF antigen or ristocetin-cofactor activity while the LVAD was in place [12]. A prospective study of 37 patients found significant loss of HMW vWF multimers within 30 days after CF-LVAD implantation [13], however, only 27% of these patients had bleeding complications, suggesting that other factors contribute to bleeding risk.…”

Section: Anticoagulation Management Of Left Ventricular Assist Devicesmentioning

confidence: 79%

“…Loss of high molecular weight (HMW) vWF multimers is believed to result from high shear stress effects on vWF multimers; this hypothesis is supported by in vitro data [10][11][12][13][14]. High shear stress changes the conformation of the large vWF multimer from a globular mass to a more linear shape, resulting in exposure of ADAMTS13 binding and cleavage sites in the A2 domain [10] Proteolysis of the vWF multimers by ADAMTS13 yields significantly smaller multimers that provide less hemostasis.…”

Section: Anticoagulation Management Of Left Ventricular Assist Devicesmentioning

confidence: 99%

Anticoagulation management of left ventricular assist devices

Connors

2014

American J Hematol

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“…The most common complication is however infection related. Other reported complications are thrombus related or malfunction of the device itself 4, 6. Iatrogenic aortic dissection after cardiac surgery using Cardiopulmonary bypass (CBP) is a rare complication with about 0.3% prevalence 5.…”

Section: Considerationsmentioning

confidence: 99%

Repair of an acute Type A aortic dissection with LVAD patient after failed mitral and tricuspid operation

Schmitto

Fleißner

Hanke

et al. 2016

Clinical Case Reports

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Acquired von Willebrand Syndrome in Continuous-Flow Ventricular Assist Device Recipients

Cited by 336 publications

References 17 publications

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Anticoagulation management of left ventricular assist devices

Repair of an acute Type A aortic dissection with LVAD patient after failed mitral and tricuspid operation

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