Von Willebrand factor, a versatile player in gastrointestinal bleeding in left ventricular assist device recipients?

Background Bleeding originating in the gastrointestinal (GI) tract is one of the most common adverse events after left ventricular assist device (LVAD) implantation. In these patients, GI bleeding appears to be the consequence of altered hemostasis on the one hand and alterations of the GI microvasc...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2015-01, Vol.55 (1), p.51-54
Main Authors: Fischer, Quentin, Huisse, Marie-Geneviève, Voiriot, Guillaume, Caron, Claudine, Lepage, Laurent, Dilly, Marie-Pierre, Nataf, Patrick, Ajzenberg, Nadine, Kirsch, Matthias
Format: Article
Language:English
Subjects:
Aged
Combined Modality Therapy
Deamino Arginine Vasopressin - therapeutic use
Drug therapy
Embolization, Therapeutic
Erythrocyte Transfusion
Fibrinogen - therapeutic use
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - therapy
Heart Ventricles
Heart-Assist Devices - adverse effects
Hemorrhage
Hemostatics - therapeutic use
Humans
Laser Coagulation
Male
Neovascularization, Physiologic - drug effects
Postoperative Hemorrhage - etiology
Postoperative Hemorrhage - therapy
Recurrence
Tranexamic Acid - therapeutic use
von Willebrand Factor - physiology
von Willebrand Factor - therapeutic use
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Summary:Background Bleeding originating in the gastrointestinal (GI) tract is one of the most common adverse events after left ventricular assist device (LVAD) implantation. In these patients, GI bleeding appears to be the consequence of altered hemostasis on the one hand and alterations of the GI microvasculature on the other. Case Report We report the case of a patient who suffered repeated, severe GI bleeding early after implantation of a HeartMate II continuous‐flow LVAD. Results After failure of conventional treatment strategies, GI bleeding was controlled using repeated transfusions of a purified von Willebrand factor (VWF) concentrate, almost devoid of Factor VIII (Wilfactin, LFB). No episodes of pump thrombosis were noted. Subsequent to VWF transfusions, we observed a progressive normalization of circulating vascular endothelial growth factor levels. Conclusions Our data raise the possibility that, in addition to its hemostatic properties, transfusions of VWF might have acted as an antiangiogenic factor.
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.12788