Ambient hemolysis and activation of coagulation is different between Heart Mate II and Heart Ware left ventricular assist devices

作者：Birschmann Ingvild^*; Dittrich Marcus; Eller Thomas; Wiegmann Bettina; Reininger Armin J; Budde Ulrich; Strueber Martin

来源：Journal of Heart and Lung Transplantation, 2014, 33(1): 80-87.

DOI：10.1016/j.healun.2013.11.010

• thromboembolic event
• bleeding events
• left ventricular assist device
• aquired von Willebrand syndrome
• platelet function
• anti-platelet drugs

BACKGROUND: Thromboembolic and bleeding events in patients with a left ventricular assist device (LVAD) are still a major cause of complications. Therefore, the balance between anti-coagulant and procoagulant factors needs to be tightly controlled. The principle hypothesis of this study is that different pump designs may have an effect on hemolysis and activation of the coagulation system. Referring to this, the HeartMate II (HMII; Thoratec Corp, Pleasanton, CA) and the HeartWare HVAD (HeartWare International Inc, Framingham, MA) were investigated.
METHODS: For 20 patients with LVAD support (n = 10 each), plasma coagulation, full blood count, and clinical chemistry parameters were measured. Platelet function was monitored using platelet aggregometry, platelet function analyzer-100 system ( Siemens, Marburg, Germany), vasodilator-stimulated phosphoprotein phosphorylation assay, immature platelet fraction, platelet-derived microparticles, and von Willebrand diagnostic.
RESULTS: Acquired von Willebrand syndrome could be detected in all patients. Signs of hemolysis, as measured by lactate dehydrogenase levels (mean, 470 U/liter HMR, 250 U/liter HVAD; p < 0.001), were more pronounced in the HMI[ patients. In contrast, D-climer analysis indicated a significantly higher activation of the coagulation system in HVAD patients (mean, 0.94 mg/liter HMII, 2.01 mg/liter HVAD; p < 0.01). The efficacy of anti-platelet therapy using clopidogrel was not sufficient in more than 50% of the patients.
CONCLUSIONS: Our results support the finding that all patients with rotary blood pumps suffered from von Willebrand syndrome. In addition, a distinct footprint of effects on hemolysis and the coagulation system can be attributed to different devices. As a consequence, the individual status of the coagulation system needs to be controlled in long-term patients.

• 出版日期2014-1