Acquired von Willebrand Syndrome in Patients With a Centrifugal or Axial Continuous Flow Left Ventricular Assist Device

Meyer, Anna; Malehsa, D.; Budde, Ulrich; Bara, Christoph; Haverich, Axel; Strueber, M.

doi:10.1016/j.jchf.2013.10.008

Cited by 199 publications

(151 citation statements)

References 16 publications

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“…All rotary pumps induce avWS and all patients are affected to some degree; however, not all patients experience clinical bleeding. Indeed, one study found that there was no correlation between the degree of decrease in HMWMs and the tendency for bleeding in patients with CF LVAD (4 had a history of bleeding events, all of whom had impaired ristocetin-induced platelet aggregation (6). The authors found that this was a consequence of both avWS and attenuated platelet function.…”

Section: Strike 1: Cf Lvad Induced Bleeding Diathesismentioning

confidence: 99%

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

Patel¹,

Vukelic²,

Jorde³

2016

J. Thorac. Dis.

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Section: Strike 1: Cf Lvad Induced Bleeding Diathesismentioning

confidence: 99%

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

Patel¹,

Vukelic²,

Jorde³

2016

J. Thorac. Dis.

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“…12 Nearly all patients treated with MCS develop acquired von Willebrand syndrome with loss of high molecular weight von Willebrand factor multimers (Table 1). [13][14][15][16][17][18][19] The exception may be the Syncardia TAH, as three patients with normal von Willebrand multimers after TAH implantation have been reported. 20 The severity of acquired von Willebrand syndrome is similar between the HeartMate II and HVAD devices.…”

Section: Effects Of Mcs On the Hematologic Systemmentioning

confidence: 99%

“…20 The severity of acquired von Willebrand syndrome is similar between the HeartMate II and HVAD devices. 14 The association between GI bleeding and acquired von Willebrand syndrome is debated as the severity of the acquired von Willebrand syndrome is not associated with an increased risk for GI bleeding. 14 Additional investigation is underway to understand the pathophysiology of GI bleeding in LVAD patients and the role of von Willebrand factor in angiogenesis.…”

Section: Effects Of Mcs On the Hematologic Systemmentioning

confidence: 99%

Mechanical circulatory support: balancing bleeding and clotting in high-risk patients

Kreuziger

Massicotte

2015

Hematology

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Mechanical circulatory support (MCS) provides a bridge to heart transplant in children and adults with life-threatening heart failure and sustains patients ineligible for transplant. Extracorporeal membrane oxygenation (ECMO) provides temporary support for patients in cardiac or pulmonary failure through external gas exchange and continuous flow of blood. Because the median time to heart transplant exceeds event-free time on ECMO, pulsatile left ventricular assist devices (LVADs) are used to support infants and children. Continuous flow LVADs are preferred in adolescents and adults due to increased pump durability and improved overall survival. The shear stress created by the mechanical pumps cause changes in the hematologic system; acquired von Willebrand syndrome occurs in almost all patients treated with MCS. Despite the improvements in survival, major bleeding occurs in one-third of patients with a LVAD and ischemic stroke and LVAD thrombosis can affect 12% of adults and 29% of children. An antithrombotic strategy to mitigate LVAD bleeding and thrombotic complications has been tested in a randomized trial in children, but intensity of antithrombotic therapy in adults varies widely. Consensus guidelines for antithrombotic therapy during ECMO were created due to significant differences in management across centers. Because of the high risk for both bleeding and thrombotic complications, experts in hemostasis can significantly impact care of patients requiring mechanical circulatory support and are a necessary part of the management team. Learning Objectives• Understand available options for mechanical circulatory support and the impact of mechanical circulatory support on the hematologic system • Differentiate the bleeding and thrombotic risks between children and adults requiring mechanical circulatory support • Recognize possible treatment options for mechanical circulatory support thrombosis Heart failure affects Ͼ5 million adults in the United States (US) and 23 million people globally. 1 The incidence of heart failure in children is significantly less than adults with ϳ18 admissions per 100 000 children per year; however, there is significant economic impact of pediatric heart failure given the frequent need for surgical intervention and the loss of productive years in the event of a child's death. 2 The heart failure etiology also differs with age as most children have congenital heart disease and adults experience cardiomyopathy or coronary artery disease. 1

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“…Also, a recent study by Meyers et al compared low-shear centrifugal devices and axial flow devices and found no difference in the impact on vWF, suggesting mechanisms beyond shear. 53 While shear forces create changes in platelet function and erythrocyte lysis, they likely have no specific link to the lack of pulse pressure. Most studies with CF pumps have shown platelet activation, but a recent study in patients with HeartMate II devices showed no changes in platelet function (measured by soluble P-selectin and CD40L) irrespective of duration of support.…”

Section: Hematologic Functionmentioning

confidence: 99%

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

Bhimaraj¹,

Uribe²,

Suarez

2015

Methodist DeBakey Cardiovascular Journal

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Acquired von Willebrand Syndrome in Patients With a Centrifugal or Axial Continuous Flow Left Ventricular Assist Device

Abstract: AvWS developed in all patients after centrifugal or axial flow pump implantation. Different patterns of AvWS were seen between the devices as well as individually. However, the complication rates after implantation were similar.

Cited by 199 publications

References 16 publications

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

Mechanical circulatory support: balancing bleeding and clotting in high-risk patients

Physiological Impact of Continuous Flow on End-Organ Function: Clinical Implications in the Current Era of Left Ventricular Assist Devices

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