Changes in Von Willebrand factor profile predicts clinical outcomes in patients on mechanical circulatory support

Oezpeker, Cenk; Zittermann, Armin; Baurichter, Daniela; Morshuis, M.; Prohaska, W.; Kassner, Astrid; Erkilet, Gülsüm; Gummert, Jan; Milting, Hendrik

doi:10.1111/jocs.13794

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…Second, we show that the VWF in LVAD patients was hyperadhesive, activating platelets ( Figure 1 ) and enhancing VWF:CB under static and flow conditions ( Figure 4 ). VWF:CB has been previously reported to both increase 56 , 57 and decrease in LVAD patients. 35 , 58 , 59 However, reports on the latter compare VWF:CB before and after LVAD.…”

Section: Discussionmentioning

confidence: 91%

Hyperadhesive von Willebrand Factor Promotes Extracellular Vesicle-Induced Angiogenesis

Yang

Houck

Dong

et al. 2022

JACC: Basic to Translational Science

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Section: Discussionmentioning

confidence: 91%

Hyperadhesive von Willebrand Factor Promotes Extracellular Vesicle-Induced Angiogenesis

Yang

Houck

Dong

et al. 2022

JACC: Basic to Translational Science

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“…57 In more than 200 patients on long-term pulsatile and continuous-flow MCS, development of AVWS, vWF:Ag and vWF:RCo levels was predictive of bleeding. 59 The incidence of bleeding is significantly higher with non-pulsatile, continuous-flow assist devices than that with pulsatile-flow devices. Even using the same non-pulsatile device (ex vivo ECMO circuit), lowering the flow rate may enhance the loss of HMWMs.…”

Section: Mcs But Adaptations Of the Platelet Function Analyser And Vi...mentioning

confidence: 99%

Optimal Tests to Minimise Bleeding and Ischaemic Complications in Patients on Extracorporeal Membrane Oxygenation

et al. 2021

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Patients receiving left-sided mechanical circulatory support (MCS) require systemic anticoagulation with unfractionated heparin (UFH) to prevent clotting of the circuit and reduce the risk of arterial thrombosis. With MCS, there is a very high frequency of bleeding and ischaemic complications, including stroke and systemic embolism. Monitoring of UFH can be very challenging. Whilst most centres routinely monitor the activated clotting time, prothrombin time, activated partial thromboplastin time (aPTT) and fibrinogen to assess haemostasis, there is no clear guidance available regarding the optimal test. Additional tests, including antithrombin level, anti-factor Xa assay and thromboelastography can be used for risk stratification of patients to try and predict the risks of thrombosis and bleeding. Each has their specific role, strengths and limitations. Measurement of anti-Xa level best correlates with heparin dose, and appears predictive of circuit thrombosis, although aPTT is a better predictor of bleeding. Increased thrombin generation may have a role in predicting thrombosis. Acquired von Willebrand syndrome is frequent with MCS, contributing to bleeding risk and can be detected by assessing the von Willebrand factor activity to antigen ratio, whilst the Platelet Function Analyzer can be used in urgent situations with high negative predictive value. Tests of platelet aggregation can aid the prediction bleeding. A selection of complementary tests to collectively assess heparin-effect, coagulation, platelet function and platelet aggregation is recommended to personalise management and thereby optimise outcomes in patients receiving MCS.

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“…10 In addition, pulsatile circulatory support has certain advantages compared with continuous flow pumps regarding the microvasculature or coagulation state of the patient. [10][11][12] However, pulsatile devices like the intra-aortic balloon pump (IABP) have failed to improve overall mortality in cardiogenic shock due to relatively low circulatory support of <0.5 litres/min. 13,14 Impaired right ventricular pulsatility is associated with an increase in mortality in end-stage heart failure patients.…”

Section: Pathophysiology Of Right Ventricular Failurementioning

confidence: 99%

Acute right heart failure: future perspective with the PERKAT RV pulsatile right ventricular support device

Ferrari

Schulze

Kretzschmar

2020

Therapeutic Advances in Cardiovascular Disease

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Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for rapid minimal invasive circulatory right heart support. The PERKAT RV is such a device for acute therapy in congestive heart failure. It reduces the central venous pooling by pumping blood from the inferior vena cava into the pulmonary artery with flow rates of up to 4 litres/min. The device was evaluated in an animal model of acute pulmonary embolism after careful in vitro tests. PERKAT RV increased cardiac output by 59% in sheep suffering from acute right heart failure. We await the first human implantation in the near future. Based on the PERKAT concept, future devolvement will also focus on left heart support.

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Changes in Von Willebrand factor profile predicts clinical outcomes in patients on mechanical circulatory support

Abstract: Our data indicate that AvWS is present in heart failure patients before device implantation, and is independently associated with clinical outcomes, especially with 1-year mortality.

Cited by 9 publications

References 22 publications

Hyperadhesive von Willebrand Factor Promotes Extracellular Vesicle-Induced Angiogenesis

Hyperadhesive von Willebrand Factor Promotes Extracellular Vesicle-Induced Angiogenesis

Optimal Tests to Minimise Bleeding and Ischaemic Complications in Patients on Extracorporeal Membrane Oxygenation

Acute right heart failure: future perspective with the PERKAT RV pulsatile right ventricular support device

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