Effects of HeartWare ventricular assist device on the von Willebrand factor: results of an academic Belgian center

BMC Cardiovascular Disorders

Research Article

Jean-François Argacha¹  Fatemeh Esmaeilzadeh²  Philippe van de Borne²  Aurélien Wauters²  Walter Wijns³ 

[1] Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium;Department of Cardiology, Université Libre de Bruxelles (ULB), 808 Lennik Street, 1070, Brussels, Belgium;Laboratory of Haemostasis, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium;

关键词: HeartWare;    Left ventricle assist device;    von Willebrand factor;    ADAMTS13;    Bleeding;   

DOI  :  10.1186/s12872-016-0334-z

 received in 2016-05-05, accepted in 2016-07-23,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundLeft Ventricular Assist Device (LVAD) is a promising therapy for patients with advanced heart failure (HF), but bleeding complications remain an important issue. Previous series show that acquired von Willebrand syndrome was present in up to 100 % of first generation LVAD recipients. We report the effects of new generation LVADs on vW factor (vWF) metabolism and activity in our center.MethodsFifteen LVAD recipients (HeartWare®, Framingham, MA, USA) were compared to 12 HF patients, matched for age and body mass index. vWF antigen and activity, as well as D-dimers, were measured on hemostasis analyzers. A vWF LVAD-induced alteration was evocated when the [vWF activity]/[vWF antigen] ratio was <0.6. ADAMTS13 and high molecular weight multimers of vWF were also assessed.ResultsLVAD recipients had similar levels of endothelial vWF production than the HF subjects (137 ± 14.5 vs. 147 ± 11.7 %; respectively, p = 0.611) but a decreased vWF activity (90 ± 11 vs. 132.6 ± 13 %; respectively, p = 0.017). [vWF activity]/[vWF antigen] ratio was 0.65 ± 0.02 in the LVAD recipients and 0.92 ± 0.06 in the subjects with HF (p = 0.001). ADAMTS13 activity was 80.3 ± 4.7 % in LVAD recipients and 96.2 ± 3.5 % in the HF patients (p = 0.016). LVAD patients disclosed markedly elevated D-dimers (3217.7 ± 735 vs. 680.6 ± 223.2 ng/mL FEU in the HF patients, p = 0.006). The LVAD patients experienced one major hemorrhagic event and one systemic thrombotic event during the median follow-up of 345 days.ConclusionsLVAD recipients achieved a new hemostatic equilibrium characterized by infrequent major hemorrhagic and thrombotic events, despite a mildly impaired vWF function and a markedly enhanced thrombin formation.Trial registrationISRCTN39517567

【 授权许可】

CC BY   
© The Author(s). 2016