Non-surgical bleeding in patients with ventricular assist devices could be explained by acquired von Willebrand disease☆

Abstract

Non-surgical postoperative bleeding after VAD implantation could be explained by an AVWD. Several pharmacologic treatment options (tranexamic acid, desmopressin, VWF-factor VIII concentrate, recombinant factor VIIa) may arise from our data. Improved VAD design could prevent this problem in the future.

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

“…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.…”

Pathophysiology of Bleeding and Clotting in the Cardiac Surgery Patient

“…It is hypothesized that because of the high shear stress generated by left ventricular assist devices, the vWF multimers are elongated, and thus cleavage sites become exposed to metalloproteinase ADAMTS13, which then cleaves the hemostatic high-molecular-weight vWF multimers. 36 Similar to Heyde's syndrome, this leads to acquired vWD. 36 …”

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

“…and ultimately increasing proteolysis of vWF (2,3). The consequence is a specific loss of the high molecular weight multimers (HMWM) of vWF which are considered to be a potent bridge in platelet adhesion to vascular endothelial surfaces, especially in areas of high blood velocity.…”