Decreased Platelet Specific Receptor Expression of P-Selectin and GPIIb/IIIa Predict Future Non-Surgical Bleeding in Patients after Left Ventricular Assist Device Implantation

• Published in: International journal of molecular sciences 2022-09, Vol.23 (18), p.10252
• Main Authors: Klaeske, Kristin, Meyer, Anna L, Saeed, Diyar, Eifert, Sandra, Jawad, Khalil, Sieg, Franz, Haunschild, Josephina, Borger, Michael A, Dieterlen, Maja-Theresa
• Format: Article
• Language: English
• Subjects: Biomarkers; Bleeding; Blood platelets; Blood Platelets - metabolism; CD63 antigen; Composition; Flow cytometry; Heart; heart failure; Heart Failure - metabolism; Heart-Assist Devices - adverse effects; Hematoma; Hematuria; Hemoglobin; Hemorrhage; Humans; Implantation; mechanical circulatory support; Medical equipment; non-physiological shear stress; non-surgical bleeding; Oxidative stress; P-selectin; P-Selectin - metabolism; Patients; Physiology; platelet dysfunction; Platelet Glycoprotein GPIIb-IIIa Complex - metabolism; Shear stress; Thrombosis; Ventricle; Von Willebrand factor; von Willebrand Factor - metabolism
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms231810252

Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. The increased shear stress leads to an altered platelet receptor composition. Whether these changes increase the risk for NSB is unclear. Thus, we compared the platelet receptor composition of patients with (bleeder group, n = 18) and without NSB (non-bleeder group, n = 18) prior to LVAD implantation. Blood samples were obtained prior to LVAD implantation and after bleeding complications in the post-implant period. Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Bleeders and non-bleeders were comparable regarding clinical characteristics, von Willebrand factor diagnostics and the aggregation capacity before and after LVAD implantation (p > 0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (33%; n = 6), epistaxis (22%; n = 4), hematuria or hematoma (17%; n = 3, respectively) and cerebral bleeding (11%; n = 2). Prior to LVAD implantation, a restricted surface expression of the platelet receptors P-selectin and GPIIb/IIIa was observed in the bleeder group (P-selectin: 7.2 ± 2.6%; GPIIb/IIIa: 26,900 ± 13,608 U) compared to non-bleeders (P-selectin: 12.4 ± 8.1%, p = 0.02; GPIIb/IIIa: 36,259 ± 9914 U; p = 0.02). We hypothesized that the reduced platelet receptor expression of P-selectin and GPIIb/IIIa prior to LVAD implantation may be linked to LVAD-related NSB.