Non-surgical bleeding in patients with ventricular assist devices could be explained by acquired von Willebrand disease☆

Geisen, Ulrich; Heilmann, Claudia; Beyersdorf, Friedhelm; Benk, Christoph; Berchtold‐Herz, Michael; Schlensak, Christian; Budde, Ulrich; Zieger, Barbara

doi:10.1016/j.ejcts.2007.12.047

Cited by 311 publications

(239 citation statements)

References 20 publications

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“…In addition, bleeding events occurred even in the absence of supratherapeutic anticoagulation, 30,32 a fact also seen in our study where 82% of the patients with bleeding had an INR within the desired therapeutic range. Other factors have been implicated in the increased incidence of bleeding in CF-LVADs, including the development of acquired von Willebrand syndrome, 14,16,17,33,34 impairment in platelet aggregation, 15 and the lack of pulsatility. The potential role of the first 2 factors in the bleeding diathesis observed in patients with CF-LVADs has been investigated; however, the role of pulsatility in this setting is less clear.…”

Section: Discussionmentioning

confidence: 99%

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Wever-Pinzon

Selzman

Drakos

et al. 2013

Circ: Heart Failure

207

109

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Background— Bleeding is an important cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs). Reduced pulsatility has been implicated as a contributing cause. The aim of this study was to assess the effects of different degrees of pulsatility on the incidence of nonsurgical bleeding. Methods and Results— The Utah Transplantation Affiliated Hospitals (U.T.A.H.) heart failure and transplant program databases were queried for patients with end-stage heart failure who required support with the continuous-flow LVAD HeartMate II (Thoratec Corp, Pleasanton, CA) between 2004 and 2012. Pulsatility was evaluated by means of the LVAD parameter pulsatility index (PI) and by the echocardiographic assessment of aortic valve opening during the first 3 months of LVAD support. PI was analyzed as a continuous variable and also stratified according to tertiles of all the PI measurements during the study period (low PI: <4.6, intermediate PI: 4.6–5.2, and high PI: >5.2). Major nonsurgical bleeding associated with a decrease in hemoglobin ≥2 g/dL (in the absence of hemolysis) was the primary end point. A total of 134 patients (median age of 60 [interquartile range: 49–68] years, 78% men) were included. Major bleeding occurred in 33 (25%) patients (70% gastrointestinal, 21% epistaxis, 3% genitourinary, and 6% intracranial). In multivariable analysis, PI examined either as a categorical variable, low versus high PI (hazard ratio, 4.06; 95% confidence interval, 1.35–12.21; P =0.04), or as a continuous variable (hazard ratio, 0.60; 95% confidence interval, 0.40–0.92; P =0.02) was associated with an increased risk of bleeding. Conclusions— Reduced pulsatility in patients supported with the continuous-flow LVAD HeartMate II is associated with an increased risk of nonsurgical bleeding, as evaluated by PI.

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Section: Discussionmentioning

confidence: 99%

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Wever-Pinzon

Selzman

Drakos

et al. 2013

Circ: Heart Failure

207

109

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“…It is hypothesized that because of the high shear stress generated by left ventricular assist devices, the vWF multimers are elongated, and thus cleavage sites become exposed to metalloproteinase ADAMTS13, which then cleaves the hemostatic high-molecular-weight vWF multimers. 36 Similar to Heyde's syndrome, this leads to acquired vWD. 36 …”

Section: Bleeding Complications With Mcad Therapymentioning

confidence: 99%

Pathophysiology of Bleeding and Clotting in the Cardiac Surgery Patient

et al. 2010

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“…and ultimately increasing proteolysis of vWF (2,3). The consequence is a specific loss of the high molecular weight multimers (HMWM) of vWF which are considered to be a potent bridge in platelet adhesion to vascular endothelial surfaces, especially in areas of high blood velocity.…”

Section: Strike 1: Cf Lvad Induced Bleeding Diathesismentioning

confidence: 99%

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

Patel¹,

Vukelic²,

Jorde³

2016

J. Thorac. Dis.

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Non-surgical bleeding in patients with ventricular assist devices could be explained by acquired von Willebrand disease☆

Cited by 311 publications

References 20 publications

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Pulsatility and the Risk of Nonsurgical Bleeding in Patients Supported With the Continuous-Flow Left Ventricular Assist Device HeartMate II

Pathophysiology of Bleeding and Clotting in the Cardiac Surgery Patient

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

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