Kavitha Muthiah1, David Connor2, Ken Ly2, Elizabeth E Gardiner3, Robert K Andrews3, Jianlin Qiao3, Darren Rutgers4, Desiree Robson4, Joyce Low2, Susan Jarvis2, Peter Macdonald1, Kumud Dhital5, Paul Jansz5, Joanne Joseph6, Christopher S Hayward7. 1. Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia;; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia. 2. Department of Haematology, St. Vincent's Hospital, Sydney, New South Wales, Australia. 3. Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia. 4. Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia; 5. Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia;; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia. 6. Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Haematology, St. Vincent's Hospital, Sydney, New South Wales, Australia. 7. Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia;; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia. Electronic address: cshayward@stvincents.com.au.
Abstract
BACKGROUND: Bleeding and thromboembolic events are identified complications in patients supported with newer centrifugal continuous-flow left ventricular assist devices (cfLVADs). Bleeding events have been associated with acquired von Willebrand syndrome (vWS) in these patients, though longitudinal changes and the effect of pulsatility remain unquantified. We evaluated longitudinal effects of third-generation cfLVADs on hemostatic biomarkers, non-surgical bleeding, and thromboembolic events. We investigated the association between pulsatility (as defined by aortic valve opening) on von Willebrand Factor (VWF) profile and bleeding. METHODS: We prospectively studied 28 patients implanted with the HeartWare (HeartWare International, Framingham, MA) cfLVAD for up to 360 days. We performed bleeding and coagulation assays 8 times from pre-implant to Day 360 (D360) post-implant, including platelet aggregometry, VWF collagen binding activity-to-antigen (CBA/Ag) ratio, thromboelastography, soluble P-selectin, platelet-specific marker soluble glycoprotein VI (sGPVI), and platelet microparticles. Aortic valve opening was assessed by echocardiography at each assessment. Bleeding and thromboembolic events were documented. RESULTS: Bleeding events occurred in 14 patients (50%). Maximal platelet inhibition occurred by D30. VWF profile impairment (VWF CBA/Ag < 0.8) was demonstrated in 89% of patients at D30, with subsequent recovery but further deterioration after D180. Bleeding was associated with elevated pre-implant sGPVI (p = 0.008). Pulsatility was associated with higher VWF CBA/Ag (p = 0.02) and a trend to less bleeding. CONCLUSIONS: Third-generation cfLVADs were associated with longitudinal changes in hemostatic markers, and bleeding was associated with elevated pre-implant plasma sGPVI. Further, pulsatility may contribute to recovery of the VWF profile and potentially lower bleeding risk. Crown
BACKGROUND:Bleeding and thromboembolic events are identified complications in patients supported with newer centrifugal continuous-flow left ventricular assist devices (cfLVADs). Bleeding events have been associated with acquired von Willebrand syndrome (vWS) in these patients, though longitudinal changes and the effect of pulsatility remain unquantified. We evaluated longitudinal effects of third-generation cfLVADs on hemostatic biomarkers, non-surgical bleeding, and thromboembolic events. We investigated the association between pulsatility (as defined by aortic valve opening) on von Willebrand Factor (VWF) profile and bleeding. METHODS: We prospectively studied 28 patients implanted with the HeartWare (HeartWare International, Framingham, MA) cfLVAD for up to 360 days. We performed bleeding and coagulation assays 8 times from pre-implant to Day 360 (D360) post-implant, including platelet aggregometry, VWF collagen binding activity-to-antigen (CBA/Ag) ratio, thromboelastography, soluble P-selectin, platelet-specific marker soluble glycoprotein VI (sGPVI), and platelet microparticles. Aortic valve opening was assessed by echocardiography at each assessment. Bleeding and thromboembolic events were documented. RESULTS:Bleeding events occurred in 14 patients (50%). Maximal platelet inhibition occurred by D30. VWF profile impairment (VWF CBA/Ag < 0.8) was demonstrated in 89% of patients at D30, with subsequent recovery but further deterioration after D180. Bleeding was associated with elevated pre-implant sGPVI (p = 0.008). Pulsatility was associated with higher VWF CBA/Ag (p = 0.02) and a trend to less bleeding. CONCLUSIONS: Third-generation cfLVADs were associated with longitudinal changes in hemostatic markers, and bleeding was associated with elevated pre-implant plasma sGPVI. Further, pulsatility may contribute to recovery of the VWF profile and potentially lower bleeding risk. Crown
Authors: Paul Vulliamy; Samantha J Montague; Scarlett Gillespie; Melissa V Chan; Lucy A Coupland; Robert K Andrews; Timothy D Warner; Elizabeth E Gardiner; Karim Brohi; Paul C Armstrong Journal: Blood Adv Date: 2020-06-23
Authors: Supriya Shore; Thomas C Hanff; Jeremy A Mazurek; Arieh Fox; Monique S Tanna; Edward W Grandin; Robert Zhang; Joyce Wald; Carli Peters; Michael A Acker; Pavan Atluri; J Eduardo Rame; Lee R Goldberg; Mariell Jessup; Kenneth B Margulies; Edo Y Birati Journal: J Clin Med Date: 2022-08-03 Impact factor: 4.964