Alterations in coagulation after implantation of a pulsatile Novacor LVAD and the axial flow micromed DeBakey LVAD

The Biological Basis of Thrombosis and Bleeding in Patients with Ventricular Assist Devices

“…Furthermore, increased levels of fibrinolysis as evidenced by increased D-dimers and fibrin degradation products were also seen in LVAD patients. These findings have also been confirmed by other investigators [28][29][30][31]. Livingston et al studied eight subjects undergoing coronary artery bypass grafting (CABG) and seven patients undergoing HeartMate LVAD insertion.…”

“…In this study, patients were followed for a 6-week period following LVAD insertion. Levels of β-TG, PF4, Factor XIIa, TAT complexes, and D-dimers were elevated in both groups [30].…”

Pulsatile Cardiopulmonary Bypass With Intra-Aortic Balloon Pump Improves Organ Function and Reduces Endothelial Activation

“…Following this, we found better preserved coagulative and fibrinolytic pathways (higher fibrinogen and AT-III, lower INR, aPTT, and D-dimer), suggesting a lower rate of consumption, in patients undergoing pulsatile perfusion. Moreover, different authors agree with our results, 2, 22 showing lower coagulopathy, inflammation and need for transfusions when pulsatile flows are used. As a direct consequence of the lower inflammatory response, the higher PLT, the better coagulative and fibrinolytic pathways, patients in Group B required less transfusions of platelets and plasma.…”

“…22 However, although corresponding qualitative data are not available in vivo, published studies on the differences between non-pulsatile and IABP-induced pulsatile perfusion during CPB suggest the net effect of the IABP on the perfusion of different organs and vascular beds. 5-8, 23 On the other hand, little is known about the pathophysiology; a recent study demonstrated that the maintenance of a steady pulsatile flow (in vitro) induces a steady shear stress on the endothelial cells, which remain in a "quiescent" state.…”

Flow-Induced Platelet Activation in Bileaflet and Monoleaflet Mechanical Heart Valves

“…6 The main complication of MHVs is thromboembolism, resulting especially in ischemic attacks and stroke. Recent studies conducted in animals 30 and patients 9,17 strongly indicate that platelet activation is a major underlying mechanism in thromembolism. It was reported recently (REMATCH study) 29 that Left Ventricular Assist Devices (LVAD) are superior to drug therapy, paving the way for their ultimate use-a long-term heart replacement therapy for patients not eligible for heart transplants.…”