التفاصيل البيبلوغرافية
| العنوان: |
Bleeding in patients with continuous-flow left ventricular assist devices: acquired von Willebrand disease or antithrombotics? |
| المؤلفون: |
Consolo, Filippo1,2 (AUTHOR) consolo.filippo@unisr.it, Marasi, Alessandra3 (AUTHOR), Valle, Patrizia Della4 (AUTHOR), Bonora, Marta2 (AUTHOR), Pieri, Marina2 (AUTHOR), Scandroglio, Anna Mara2 (AUTHOR), Redaelli, Alberto3 (AUTHOR), Zangrillo, Alberto1,2 (AUTHOR), D'Angelo, Armando4 (AUTHOR), Pappalardo, Federico5 (AUTHOR) |
| المصدر: |
European Journal of Cardio-Thoracic Surgery. Jul2022, Vol. 62 Issue 1, p1-8. 8p. |
| مصطلحات موضوعية: |
*HEART assist devices, *VON Willebrand disease, *FIBRINOLYTIC agents, *INTERNATIONAL normalized ratio, *HEMORRHAGE |
| مستخلص: |
Open in new tab Download slide OBJECTIVES To evaluate the competing pro-haemorrhagic contribution of acquired von Willebrand (vW) disease and antithrombotic therapy in patients implanted with continuous-flow left ventricular assist devices (LVADs). METHODS We compared the extent of vW factor (vWf) degradation [vWf antigen (vWf:Ag)] and a decrease of functional activity of large vWf multimers [vWf collagen binding (vWf:CB)] in LVAD patients who did and did not suffer from bleeding. Data were measured pre-implant, at short-term (t1: <3 months) and long-term (t2: >12 months) follow-up. The occurrence of primary bleeding events, as well as bleeding recurrence, was correlated with patient-specific vWf profile and antithrombotic regimen. Indeed, patients were discharged on warfarin (international normalized ratio: 2–2.5) and aspirin, with the latter withhold after a first bleeding episode. RESULTS Fifty-three patients were enrolled. The median follow-up was 324 (226–468) days. We recorded 25 primary bleeding events (47% of patients). All primary events occurred in patients on warfarin and aspirin. Both vWf:Ag and vWf:CB decreased significantly post-implant (P = 0.0003 and P < 0.0001), and patients showing pathological vWf:CB/vWf:Ag ratio (<0.7) increased progressively over the time of support (pre-implant = 26%, t1 = 58%, t2 = 74%; P < 0.0001). Of note, activity of large vWf multimers of bleeders was significantly lower at t2 with respect to non-bleeders (vWf:CB: 61 (36–115) vs 100 (68–121), P = 0.04; vWf:CB/vWf:Ag ratio: 0.36 (0.26–0.61) vs 0.58 (0.33–0.96), P = 0.04). Despite these marked differences in the vWf profile, following aspirin discontinuation only 3 patients had bleeding recurrence. CONCLUSIONS Aspirin contributes significantly to haemorrhagic events in the background of acquired vW disease; its discontinuation significantly reduces bleeding recurrence. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03255928Test ; ClinicalTrials.gov Identifier: NCT03255928. [ABSTRACT FROM AUTHOR] |
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