Mechanisms of Platelet Dysfunction in Patients with Implantable Devices

Casan, Joshua; Andrews, Robert K.; Gardiner, Elizabeth E.; Davis, Amanda

doi:10.1055/s-0037-1605572

Cited by 6 publications

(6 citation statements)

References 99 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is known that patients with AS are affected by hemostasis alteration [1–6]. Initial hemostasis disorders related to AS are bidirectional, with proven high platelet activation and increased thrombin generation on one hand, and acquired deficiency of vWF or the platelet shedding phenomenon on the other [1–6, 27]. Additionally, the impact of advanced age on platelet function with increased platelet reactivity and depletion in plasma factor XIII were previously described [28–31].…”

Section: Discussionmentioning

confidence: 99%

“…Hemostasis disorders associated with AVR are partially explained by the use of extracorporeal circulation. The insufficient hemocompatibility of cardiopulmonary bypass (CPB) devices, which are negatively charged and not covered with endothelium, causes activation of plasma coagulation factors, platelets, complement components, endothelial cells and leucocytes [8, 16, 18, 27]. Subsequently, fibrinogen and vWF are adsorbed onto the surface of CPB, providing a nidus for platelet adhesion and aggregation.…”

Section: Discussionmentioning

confidence: 99%

“…A potential explanation of this phenomenon might be platelet receptor shedding related to the TAVI procedure [27, 35]. However, if so, the AVR procedure and shear forces of CPB should be more traumatic for platelets.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Peri-procedural hemostasis disorders in surgical and transcatheter aortic valve implantation

Czerwińska-Jelonkiewicz

Milewski

Buszman

et al. 2019

pwki

View full text Add to dashboard Cite

Introduction Despite their high effectiveness, surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) are associated with substantial risk of bleeding. Although procedure-related hemostasis disorders might be crucial for safety of both procedures, the amount of data on the peri-procedural status of hemostasis in patients with aortic valve stenosis (AS) subjected to AVR and TAVI is negligible. Aim To investigate the profile of peri-procedural hemostasis in elderly patients with AS, subjected to aortic valve prosthesis implantation. Material and methods We performed a prospective analysis of global hemostasis using ROTEM thromboelastometry and platelet reactivity assessment using impedance aggregometry in 30 consecutive patients ≥ 70 years old subjected to AVR and TAVI. All tests were performed within 24 h before, directly and 24 h after the procedures. Results Surgical aortic valve replacement was characterized by transient hypofibrinogenemia and von Willebrand factor (vWF) depletion, which quickly recovered within 24 h after AVR. Transcatheter aortic valve implantation was characterized by substantial alteration of platelet function and vWF depletion with significant platelet reactivity impairment and increase in platelet sensitivity to antiplatelet agent, early after the procedure. TAVI-related hemostasis alterations were not recovered at 24 h after the procedure. Conclusions Surgical and transcatheter aortic valve replacement procedures are associated with substantial and diverse peri-procedural hemostasis disorders. Since hemostasis disorders related to TAVI are mainly characterized by impaired platelet function, early dual antiplatelet prophylaxis after TAVI requires careful consideration.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Peri-procedural hemostasis disorders in surgical and transcatheter aortic valve implantation

Czerwińska-Jelonkiewicz

Milewski

Buszman

et al. 2019

pwki

View full text Add to dashboard Cite

show abstract

“…However, the mechanisms can be inferred through previous studies on several hemostatic impairments caused by direct blood-contacting devices, such as extracorporeal membrane oxygenation, and ventricular assist devices. It is well-described in the literature that the use of equipment which directly contacts the blood increases not only the risk of bleeding, but paradoxically, also the rate of thrombosis 7–9 .…”

Section: Introductionmentioning

confidence: 99%

Hemoperfusion leads to impairment in hemostasis and coagulation process in patients with acute pesticide intoxication

Park

Islam

Jeong

et al. 2019

Sci Rep

View full text Add to dashboard Cite

Hemoperfusion (HP) is one of the important treatment modalities in extracorporeal therapy for patients with acute intoxication. Its use has declined during the past 20 years despite its efficacy, because of its side effects, especially an increased risk of bleeding. Mechanisms of hemostasis impairment have not been clearly elucidated and studies demonstrating the mechanism are lacking. It is not clear which step of the hemostatic process is impaired during HP, and whether it leads to an increased risk of bleeding. We performed both in vivo and in vitro studies to elucidate the mechanism of impairment in the hemostatic process. In patients with acute pesticide intoxication who underwent HP, the platelet count decreased rapidly during the first 30 minutes from 242.4 ± 57.7 × 103/μL to 184.8 ± 49.6 × 103/μL, then gradually decreased even lower to 145.4 ± 61.2 × 103/μL over time (p < 0.001). As markers of platelet activation, platelet distribution width increased continuously during HP from 41.98 ± 9.28% to 47.69 ± 11.18% (p < 0.05), however, mean platelet volume did not show significant change. In scanning electron microscopy, activated platelets adhered to modified charcoal were observed, and delayed closure time after HP in PFA-100 test suggested platelet dysfunction occurred during HP. To confirm these conflicting results, changes of glycoprotein expression on the platelet surface were evaluated when platelets were exposed to modified charcoal in vitro. Platelet expression of CD61, fibrinogen receptor, significantly decreased from 95.2 ± 0.9% to 73.9 ± 1.6%, while those expressing CD42b, von Willebrand factor receptor, did not show significant change. However, platelet expression of CD49b, collagen receptor, significantly increased from 24.6 ± 0.7% to 51.9 ± 2.3%. Thrombin-antithrombin complex, a marker for thrombin generation, appeared to decrease, however, it was not statistically significant. Fibrin degradation products and d-dimers, markers for fibrinolysis, increased significantly during HP. Taken together, our data suggests that hemoperfusion leads to impairment of platelet aggregation with incomplete platelet activation, which was associated with reduced thrombin generation, accompanied by increased fibrinolysis.

show abstract

“…The interaction between platelets and implanted devices affects hemostasis but can also provoke an inflammatory response. The pathobiology of these processes is therefore presented by Casan et al 2 In the subsequent articles, detailed information is provided on the more commonly used devices, especially those used in cardiovascular practice. Problems encountered in cardiac support by extracorporeal membrane oxygenation are discussed by Thomas et al 3 This is followed by the description of another popular device in pediatric practice, the ventricular assist device, by Adachi et al 4 Attempts to prevent thrombotic complications after transcatheter heart valves prosthesis placement are then discussed by Sorrentino et al 5 Improved designs in coronary stents have, in recent years, expanded the lifespan of these devices, as described by Gopalakrishnan and Lofti.…”

mentioning

confidence: 99%