Changes in platelet activation associated with left ventricular assist system placement

Matsubayashi, Hidehiko; Fastenau, Dana R; McIntyre, John A.

doi:10.1016/s1053-2498(00)00088-7

Cited by 29 publications

(13 citation statements)

References 25 publications

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“…Improved device design might mitigate these risks, but subclinical markers indicating cellular biocompatibility are needed. Numerous studies have evaluated direct and indirect markers of platelet activation as well as other hemostatic indices in relation to thrombosis concerns in VAD patients (15)(16)(17)(18)(19)(20). Flow cytometric assays are particularly attractive in that they provide a snapshot of the level of circulating activated platelets (21)(22)(23)(24).…”

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confidence: 99%

Platelet Activation in Ovines Undergoing Sham Surgery or Implant of the Second Generation PediaFlow Pediatric Ventricular Assist Device

et al. 2011

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The PediaFlow™ pediatric ventricular assist device (VAD) is a magnetically levitated turbodynamic pump under development for circulatory support of small children with a targeted flow rate range of 0.3 - 1.5 L/min. As the design of this device is refined, ensuring high levels of blood biocompatibility is essential. In this study we characterized platelet activation during the implantation and operation of a second generation prototype of the PediaFlow VAD (PF2) and also performed a series of surgical sham studies to examine purely surgical effects on platelet activation. In addition, a newly available monoclonal antibody was characterized and shown to be capable of quantifying ovine platelet activation. The PF2 was implanted in 3 chronic ovine experiments of 16, 30, and 70 days, while surgical sham procedures were performed in 5 ovines with 30 d monitoring. Blood biocompatibility in terms of circulating activated platelets was measured by flow cytometric assays with and without exogenous agonist stimulation. Platelet activation following sham surgery returned to baseline in approximately 2 weeks. Platelets in PF2 implanted ovines returned to baseline activation levels in all three animals, and showed an ability to respond to agonist stimulation. Late term platelet activation was observed in one animal corresponding with unexpected pump stoppages related to a manufacturing defect in the percutaneous cable. The results demonstrated encouraging platelet biocompatibility for the PF2 in that basal platelet activation was achieved early in the pump implant period. Furthermore, this first characterization of the effect of a major cardiothoracic procedure on temporal ovine platelet activation provides comparative data for future cardiovascular device evaluation in the ovine model.

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confidence: 99%

Platelet Activation in Ovines Undergoing Sham Surgery or Implant of the Second Generation PediaFlow Pediatric Ventricular Assist Device

et al. 2011

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“…Upregulation of platelet function is described with MCS and may contribute to long-term risk of thromboembolic events. 12,13 In the case of subtherapeutic international normalized ratio, the necessity of bridging is patient specific and should be guided by the implanting center.…”

Section: Anticoagulationmentioning

confidence: 99%

Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

Cook¹,

Colvin²,

Francis³

et al. 2017

Circulation

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“…39 Despite the fact that anticoagulant therapy as well as antiplatelet therapy is titrated in accordance to laboratory findings (of which some are bedside suitable), the combined rate of bleeding and thrombotic events is still high (up to 45%). 23 Platelet function test values may change over time with high intra-and interindividual variability [40][41][42] and it is possible that some patients on MCS therapy have resistance to antiplatelet therapy. 37,38,[43][44][45] …”

Section: Thoracic and Cardiovascular Surgeonmentioning

confidence: 99%

Bleeding and Thrombotic Events in Patients Undergoing Mechanical Circulatory Support: A Review of Literature

Petričević

Miličić

Boban

et al. 2015

Thorac cardiovasc Surg

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Bleeding and thrombotic events are among the most common complications detected in patients with mechanical circulatory support (MCS). Herein, we reviewed the available evidence on the prevalence, etiology, and management of bleeding and thrombotic events in patients following MCS procedures, such as implantation of both intra- and paracorporeal devices that generate either pulsatile or nonpulsatile flow. Extracorporeal life support procedures providing support to the failing heart and lungs were also reviewed. Most bleeding and thromboembolic events occur despite appropriate hemostatic and anticoagulation management based on conventional coagulation laboratory parameters. Prevalence of bleeding events in this population ranges between 5 and 81%. Wide range in prevalence of bleeding reported in literature may be explained by different devices with different anticoagulation protocols being used, as well as different definitions of bleeding outcomes. Although bleeding events are more common than thromboembolic events, the consequences of thrombotic events are often detrimental. Management of bleeding events remains challenging and measures to prevent and treat bleeding events are often followed by thromboembolic events. Therefore, a personalized approach based on point-of-care hemostatic tests and adjusted to device type and patient comorbidities is therefore warranted. To provide advanced understanding of hemostatic disturbances during MCS, prospective trials focused on bleeding and thromboembolic events as primary endpoints should be conducted. Better understanding of the underlying pathophysiology and a shift towards a personalized approach based on functional point-of-care hemostatic properties assessment may provide more favorable clinical outcomes. This should, however, be coupled with further technological improvements providing better device surface hemocompatibility as interaction between blood and device surface affects the hemostatic equilibrium.

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Changes in platelet activation associated with left ventricular assist system placement

Cited by 29 publications

References 25 publications

Platelet Activation in Ovines Undergoing Sham Surgery or Implant of the Second Generation PediaFlow Pediatric Ventricular Assist Device

Platelet Activation in Ovines Undergoing Sham Surgery or Implant of the Second Generation PediaFlow Pediatric Ventricular Assist Device

Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

Bleeding and Thrombotic Events in Patients Undergoing Mechanical Circulatory Support: A Review of Literature

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