Severely Impaired von Willebrand Factor-Dependent Platelet Aggregation in Patients With a Continuous-Flow Left Ventricular Assist Device (HeartMate II)

• Published in: Journal of the American College of Cardiology 2009-06, Vol.53 (23), p.2162-2167
• Main Authors: Klovaite, Jolanta, MD, Gustafsson, Finn, MD, PhD, Mortensen, Svend A., MD, DMSc, Sander, Kåre, MD, DMSc, Nielsen, Lars B., MD, PhD, DMSc
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - adverse effects; Aspirin; Biochemistry; Biological and medical sciences; Blood Platelets; Cardiology; Cardiology. Vascular system; Cardiomyopathy; Cardiovascular; Drug therapy; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Enzymes; Female; Heart failure; Heart Failure - therapy; heart-assist device; Heart-Assist Devices - adverse effects; hemorrhage; Hemorrhage - etiology; Hemorrhage - physiopathology; Hemorrhage - prevention & control; Humans; Intensive care medicine; Internal Medicine; International Normalized Ratio; Male; Medical sciences; Middle Aged; Molecular weight; Patients; Plasma; Platelet Aggregation; Platelet Aggregation Inhibitors; platelets; Ristocetin - adverse effects; Stroke Volume; Studies; Ventricular Dysfunction, Left - therapy; Ventricular Function, Left; von Willebrand Factor - physiology; Young Adult
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.02.048

Objectives This study investigated the influence of the mechanical blood pump HeartMate II (HMII) (Thoratec Corporation, Pleasanton, California) on blood coagulation and platelet function. Background HMII is an implantable left ventricular assist device used for the treatment of heart failure. Patients treated with HMII have increased bleeding tendencies. Methods We measured agonist-induced platelet aggregation in 16 patients on HMII support. Results The von Willebrand factor (vWF)-dependent ristocetin-induced platelet aggregation was impaired in 11 of the 16 patients, of which 12 had experienced at least 1 minor or major bleeding episode. The impaired ristocetin-induced platelet aggregation was associated both with decreased specific activity of plasma vWF, presumably due to lack of high molecular weight vWF multimers, as well as with attenuated function of the platelets themselves. Conclusions The results imply that HMII treatment is associated with impaired platelet aggregation, which may contribute to an increased tendency to bleed.