Platelet Dysfunction in Outpatients With Left Ventricular Assist Devices

Steinlechner, Barbara; Dworschak, Martin; Birkenberg, Beatrice; Duris, Monika; Zeidler, Petra; Fischer, Henrik; Milosevic, L Verica; Wieselthaler, Georg; Wolner, Ernst; Quehenberger, Peter; Jilma, Bernd

doi:10.1016/j.athoracsur.2008.10.027

Cited by 125 publications

(102 citation statements)

References 23 publications

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“…It was proposed that vWF fragments inhibited platelet aggregation and that poor platelet reactivity played a role in bleeding. Similar findings were seen by Steinlechner et al in patients with CF-LVAD with 11 of 12 demonstrating impaired platelet function under high shear stress with impaired ristocetin-induced platelet aggregation not completely attributable to low vWF activity [16].…”

Section: Anticoagulation Management Of Left Ventricular Assist Devicessupporting

confidence: 84%

Anticoagulation management of left ventricular assist devices

Connors

2014

American J Hematol

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Section: Anticoagulation Management Of Left Ventricular Assist Devicessupporting

confidence: 84%

Anticoagulation management of left ventricular assist devices

Connors

2014

American J Hematol

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“…Cessation of life-threatening gastrointestinal bleeding episodes have been found after removal of the source of high shear stress, the aortic stenosis, 23 or the LVAD. 24 Geisen et al 11 reported nonsurgical bleeding in patients with VADs in association with acquired vWS, and Steinlechner et al 12 reported the loss of large vWF multimers in 12 outpatients with rotary blood pumps other than HeartMate II. These findings indicate that acquired vWS is present in patients with differently designed rotary blood pumps and not related to 1 particular design.…”

Section: Discussionmentioning

confidence: 99%

“…The typical laboratory findings of an acquired vWS have been demonstrated in patients with different types of VADs (Thoratec biventricular assist device HeartMate II and other rotary blood pumps). [11][12][13] To evaluate the prevalence of vWS with the use of a modern device, we analyzed outpatients on chronic support with the HeartMate II assist device and reported the hemostatic abnormalities and clinical consequences for this patient cohort. The analysis was repeated after removal of the device for transplantation or recovery as well as in the majority of ongoing patients.…”

Section: Editorial See P 647 Clinical Perspective On P 681mentioning

confidence: 99%

Acquired von Willebrand Syndrome in Patients With an Axial Flow Left Ventricular Assist Device

Meyer

Malehsa²,

Bara³

et al. 2010

Circ: Heart Failure

262

149

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Background-Rotary blood pumps used as left ventricular assist devices (LVADs) allow for long-term support and may become suitable alternatives to heart transplantation. Effects of this technology on the coagulation system are not completely understood, leading to controversial anticoagulation protocols. Thus, we investigated the primary hemostasis in patients with chronic LVAD therapy. Methods and Results-Twenty-six outpatients received axial flow LVAD (HeartMate II; Thoratec) for a median support time of 4.5 months. In a cross-sectional protocol, platelet aggregation in response to ADP and epinephrine, von Willebrand antigen (vWF:AG), and collagen-binding capacity (vWF:CB) were obtained. Von Willebrand factor (vWF) multimer analyses were performed, and patients were screened for bleeding events. This analysis was repeated after removal of the device for transplantation or recovery (nϭ12) and after a median of 15.5 months in ongoing patients (nϭ11). In all patients on devices, severe impairment of platelet aggregation as well as a loss of large vWF multimers were found. In 10 patients, a decreased vWF:CB/vWF:AG ratio was observed. Bleeding episodes occurred with an incidence of 0.17 per patient-year. After removal of the device, normal patterns of platelet aggregation, multimer analysis, and vWF:CB/vWF:AG ratio were recorded. In the second analysis of ongoing patients, impairment of platelet aggregation and loss of large vWF multimers were verified. Conclusions-A diagnosis of von Willebrand syndrome type 2 was established in all patients after LVAD implantation, and bleeding events confirmed this finding. Reversibility of this condition was found after removal of the device. (Circ Heart Fail. 2010;3:675-681.)

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“…Seit Jahren sinkt jedoch die Blutungen und Gerinnungsstörungen sind häufige Komplikationen nach Implantation eines ventrikulären Unterstützungssystems (Backes et al, 2012;Eckman and John, 2012). Aus früheren Arbeiten ist bekannt, dass Blutungsereignisse möglicherweise durch eine verschlechterte Thrombozytenfunktion zu erklären sind (Klovaite et al, 2009;Steinlechner et al, 2009). Als mögliche Ursachen kommen eine vermehrte Interaktion der Thrombozyten mit der Fremdoberfläche sowie eine pathologische hohe Schubspannung in Frage (Eckman and John, 2012).…”

Section: Introductionunclassified