Von Willebrand factor in patients on mechanical circulatory support – a double-edged sword between bleeding and thrombosis

Hudzik, Bartosz; Kaczmarski, Jacek; Pacholewicz, Jerzy; Zakliczyńśki, Michał; Gąsior, Mariusz; Zembala, Marian

doi:10.5114/kitp.2015.54459

Cited by 8 publications

(8 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…31 This issue should be considered, particularly because many VAD patients bleed postoperatively and have gastrointestinal bleeding. [32][33][34][35] According to Randi et al, patients with AVWS can develop gastrointestinal bleeding because more angiodysplasia occurs in these patients. 36 Blackshear et al noted that acquired abnormalities of VWF multimers are associated with aortic and mitral prosthesis dysfunction, with occasional gastrointestinal bleeding and gastrointestinal angiodysplasia.…”

Section: Discussionmentioning

confidence: 99%

Platelet secretion defects and acquired von Willebrand syndrome in patients with Ventricular Assist Devices

et al. 2019

View full text Add to dashboard Cite

Background--The number of implanted ventricular assist devices (VADs) has increased significantly recently. Bleeding, the most frequent complication, cannot be solely attributed to anticoagulation therapy. Acquired von Willebrand syndrome (AVWS) caused by increased shear stress is frequent in VAD patients and can increase the bleeding risk. The HeartMate III (HM III) is a novel left VAD featuring potential improvements over the HeartMate II.Methods and Results--In this study, we investigated the prevalence and onset of AVWS in 198 VAD patients. To our knowledge, this is the largest cohort of VAD patients whose longitudinal data on AVWS have been collected. We also analyzed whether AVWS is less severe in HM III patients than in HeartMate II patients. Because platelet dysfunction can raise the bleeding risk, we investigated platelet function in a subset of patients. In total, 198 VAD patients and 60 patients with heart transplants as controls were included in this study. The ratio of von Willebrand factor collagen binding capacity to von Willebrand factor:antigen, multimer analyses, and platelet function (especially secretion of aand d-granules) were investigated. All 198 VAD patients developed AVWS. As soon as the VAD was explanted, the AVWS disappeared within hours. AVWS was less severe in the HM III patients than in the HeartMate II patients. The HM III patients had fewer bleeding symptoms. In addition, VAD patients exhibited a platelet aand d-granule secretion defect.Conclusions--AVWS develops in VAD patients and may increase the bleeding risk. The HM III device causes less severe AVWS. Platelet secretion defects should be investigated in VAD patients because they also raise the bleeding risk.Clinical Trial Registration--https://www.drks.de/drks_web.

show abstract

Section: Discussionmentioning

confidence: 99%

Platelet secretion defects and acquired von Willebrand syndrome in patients with Ventricular Assist Devices

et al. 2019

View full text Add to dashboard Cite

show abstract

“…This issue should be considered, particularly because many VAD patients bleed postoperatively and have gastrointestinal bleeding . According to Randi et al, patients with AVWS can develop gastrointestinal bleeding because more angiodysplasia occurs in these patients .…”

Section: Discussionmentioning

confidence: 99%

Platelet Secretion Defects and Acquired von Willebrand Syndrome in Patients With Ventricular Assist Devices

Geisen

Brehm

Trummer

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThe number of implanted ventricular assist devices (VADs) has increased significantly recently. Bleeding, the most frequent complication, cannot be solely attributed to anticoagulation therapy. Acquired von Willebrand syndrome (AVWS) caused by increased shear stress is frequent in VAD patients and can increase the bleeding risk. The HeartMate III (HM III) is a novel left VAD featuring potential improvements over the HeartMate II.Methods and ResultsIn this study, we investigated the prevalence and onset of AVWS in 198 VAD patients. To our knowledge, this is the largest cohort of VAD patients whose longitudinal data on AVWS have been collected. We also analyzed whether AVWS is less severe in HM III patients than in HeartMate II patients. Because platelet dysfunction can raise the bleeding risk, we investigated platelet function in a subset of patients. In total, 198 VAD patients and 60 patients with heart transplants as controls were included in this study. The ratio of von Willebrand factor collagen binding capacity to von Willebrand factor:antigen, multimer analyses, and platelet function (especially secretion of α‐ and δ‐granules) were investigated. All 198 VAD patients developed AVWS. As soon as the VAD was explanted, the AVWS disappeared within hours. AVWS was less severe in the HM III patients than in the HeartMate II patients. The HM III patients had fewer bleeding symptoms. In addition, VAD patients exhibited a platelet α‐ and δ‐granule secretion defect.Conclusions AVWS develops in VAD patients and may increase the bleeding risk. The HM III device causes less severe AVWS. Platelet secretion defects should be investigated in VAD patients because they also raise the bleeding risk.Clinical Trial Registration https://www.drks.de/drks_web. Unique identifier: DRKS00000649.

show abstract

“…VWF in patients on mechanical circulatory support is a double-edged sword: absence of large multimers leads to bleeding, but replacement therapy or excess endogenous VWF promotes thrombosis. 49 The optimal dose and frequency of VWF replacement in patients on ECMO have not been established.…”

Section: Acquired Von Willebrand Syndromementioning

confidence: 99%

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Thomas

Kostousov

Teruya

2017

Semin Thromb Hemost

230

197

View full text Add to dashboard Cite

Extracorporeal membrane oxygenation (ECMO) has been used for >40 years to support lung and heart failure; however, bleeding and thrombosis remain serious complications. The known etiologies of bleeding include heparin effect or overdose, coagulopathy, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis. Bleeding sites may include cannula insertion sites, recent surgical incisions, vascular access sites, lung, gastrointestinal tract, mouth, nose, thoracic cavity, abdominal cavity, and brain. Massive bleeding in the brain, the most feared bleeding complication, can be rapidly fatal because it occurs in a rigid closed space, is difficult to drain, and cannot be stopped with direct pressure to the bleeding site. Pulmonary hemorrhage may cause irreversible lung damage. Management should be swift and precise to prevent fatal bleeding. In contrast, etiologies of thrombosis include high fibrinogen and factor VIII levels, heparin resistance, and platelet activation. Achieving the optimal anticoagulation balance to prevent bleeding and thrombosis in ECMO patients is extremely complex. Experts in hemostasis should be a part of an institutional ECMO team and continuously available for immediate management.

show abstract

Von Willebrand factor in patients on mechanical circulatory support – a double-edged sword between bleeding and thrombosis

Cited by 8 publications

References 21 publications

Platelet secretion defects and acquired von Willebrand syndrome in patients with Ventricular Assist Devices

Platelet secretion defects and acquired von Willebrand syndrome in patients with Ventricular Assist Devices

Platelet Secretion Defects and Acquired von Willebrand Syndrome in Patients With Ventricular Assist Devices

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Contact Info

Product

Resources

About