Bleeding in patients with continuous-flow left ventricular assist devices: acquired von Willebrand disease or antithrombotics?
| العنوان: | Bleeding in patients with continuous-flow left ventricular assist devices: acquired von Willebrand disease or antithrombotics? |
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| المؤلفون: | Marina Pieri, Alberto Redaelli, Armando D'Angelo, Filippo Consolo, Anna Mara Scandroglio, Patrizia Della Valle, Federico Pappalardo, Alessandra Marasi, Marta Bonora, Alberto Zangrillo |
| المساهمون: | Consolo, Filippo, Marasi, Alessandra, Della Valle, Patrizia, Bonora, Marta, Pieri, Marina, Scandroglio, Anna Mara, Redaelli, Alberto, Zangrillo, Alberto, D'Angelo, Armando, Pappalardo, Federico |
| المصدر: | European Journal of Cardio-Thoracic Surgery. 62 |
| بيانات النشر: | Oxford University Press (OUP), 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Pulmonary and Respiratory Medicine, medicine.medical_specialty, Left ventricular assist device, Hemorrhage, Von Willebrand factor, Fibrinolytic Agents, Internal medicine, von Willebrand Factor, Antithrombotic, medicine, Von Willebrand disease, Humans, In patient, Pathological, Antithrombotic therapy, Aspirin, biology, business.industry, Bleeding, General Medicine, medicine.disease, Discontinuation, von Willebrand Diseases, Regimen, Cardiology, biology.protein, Surgery, Warfarin, Heart-Assist Devices, Cardiology and Cardiovascular Medicine, business, medicine.drug |
| الوصف: | 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: 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 ( 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. |
| تدمد: | 1873-734X 1010-7940 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::def3e56e9594f3878941d4be48f4573fTest https://doi.org/10.1093/ejcts/ezab474Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....def3e56e9594f3878941d4be48f4573f |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 1873734X 10107940 |
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