دورية أكاديمية
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: | 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 ; volume 62, issue 1 ; ISSN 1010-7940 1873-734X |
| بيانات النشر: | Oxford University Press (OUP) |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Cardiology and Cardiovascular Medicine, Pulmonary and Respiratory Medicine, General Medicine, Surgery |
| 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: <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. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1093/ejcts/ezab474 |
| الإتاحة: | https://doi.org/10.1093/ejcts/ezab474Test https://academic.oup.com/ejcts/article-pdf/62/1/ezab474/44411759/ezab474.pdfTest |
| حقوق: | https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_modelTest |
| رقم الانضمام: | edsbas.D0F7B102 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1093/ejcts/ezab474 |
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