Platelet activation is a preoperative risk factor for the development of thromboembolic complications in patients with continuous‐flow left ventricular assist device. (28th December 2017)

• Record Type: Journal Article
• Authors: Consolo, Filippo; Sferrazza, Giulia; Motolone, Giulia; Contri, Rachele; Valerio, Lorenzo; Lembo, Rosalba; Pozzi, Loris; Della Valle, Patrizia; De Bonis, Michele; Zangrillo, Alberto; Fiore, Gianfranco B.; Redaelli, Alberto; Slepian, Marvin J.; Pappalardo, Federico
• Is Part Of: European journal of heart failure. Volume 20:Number 4(2018)
• Page Start: 792
• Page End: 800
• Publication Date: 2017-12-28
• Subjects: Left ventricular assist device -- Thrombotic risk -- Platelet activation -- Platelet activity state assay -- Antithrombotic therapy; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.1113
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract : Aims: To correlate the dynamics of platelet activation with the development of thromboembolic events in patients with continuous‐flow left ventricular assist device (cf‐LVAD). Methods and results: The platelet activity state (PAS) assay was utilized to evaluate platelet activation in 68 cf‐LVAD patients implanted with the HeartMate II ( n = 15, 22%), HeartMate 3 ( n = 15, 22%), or HeartWare HVAD ( n = 38, 56%). PAS was measured preoperatively, early post‐implant, and at long‐term follow‐up (1, 3, 6, 12, 18, and 24 months post‐implant). PAS was also measured at the occurrence of adverse events in patients who developed thrombotic complications. Data on patient demographics, medical history, antithrombotic therapy, and coagulation parameters were also analysed. Over a median follow‐up of 602 (234–942) days, PAS values did not increase over time in the overall population ( P = 0.15). However, PAS measured at event was 15‐fold higher in the six patients (9%) who suffered pump thrombosis ( n = 2) or ischaemic stroke ( n = 4) vs. the rest of the population [6.67% (5.59%–11.98%) vs. 0.45% (0.33%–0.75%); P = 0.012], despite comparable coagulation profile. Pre‐implant PAS values were 4.5‐fold higher in these patients [1.90% (1.24%–3.17%) vs. 0.42% (0.32%–0.72%); P = 0.006]. Neither preoperative variables nor the type of the pump or the antiplatelet strategy were associated with a higher risk of complications. Conclusions: Thrombotic events are associated with altered PAS values. Moreover, baseline elevated PAS values in patients who developed thrombotic events suggest patient‐specific tendency to post‐implant thromboembolic complications. Prospectively, systematic monitoring of PAS might guide the development of refined patient‐tailored antithrombotic strategies and the technological improvement of LVAD design.