Acquired von Willebrand Syndrome in Patients With an Axial Flow Left Ventricular Assist Device
Acquired von Willebrand Syndrome in Patients With an Axial Flow Left Ventricular Assist Device
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DOI：
10.1161/circheartfailure.109.877597
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发表时间：
2010-11-01
影响因子：
9.7
通讯作者：
Strueber, Martin
中科院分区：
文献类型：
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作者：
Meyer, Anna L.;Malehsa, Doris;Strueber, Martin
背景-作为左心室辅助装置(LVAD)的旋转血泵允许长期支持，并可能成为心脏移植的合适替代品。这项技术对凝血系统的影响尚不完全清楚，导致了有争议的抗凝方案。因此，我们调查了慢性LVAD患者的初次止血情况。方法和结果-26名门诊患者接受了轴向血流LVAD(HeartMate II；Thoratec)，中位支持时间为4.5个月。在横断面方案中，获得了对ADP和肾上腺素反应的血小板聚集、von Willebrand抗原(vWF：Ag)和胶原结合能力(vWF：CB)。进行von Willebrand因子(VWF)多聚体分析，并对患者进行出血事件筛查。在取出移植或恢复装置后(n=12)和正在进行中的患者(n=11)的中位数15.5个月后重复这一分析。在所有使用设备的患者中，发现严重的血小板聚集功能障碍以及大的vWF多聚体丢失。10例患者vWF：CB/vWF：Ag比值降低。出血事件的发生率为0.17/病人年。取下装置后，记录正常的血小板聚集模式、多聚体分析和vWF：CB/vWF：Ag比值。在对正在进行的患者的第二次分析中，证实了血小板聚集功能障碍和大的vWF多聚体丢失。结论-所有患者在LVAD植入后都被诊断为2型von Willebrand综合征，出血事件证实了这一发现。在移除该装置后，发现这种情况是可逆的。(中国保监会心力衰竭。2010；3：675-681。)
Background-Rotary blood pumps used as left ventricular assist devices (LVADs) allow for long-term support and may become suitable alternatives to heart transplantation. Effects of this technology on the coagulation system are not completely understood, leading to controversial anticoagulation protocols. Thus, we investigated the primary hemostasis in patients with chronic LVAD therapy.Methods and Results-Twenty-six outpatients received axial flow LVAD (HeartMate II; Thoratec) for a median support time of 4.5 months. In a cross-sectional protocol, platelet aggregation in response to ADP and epinephrine, von Willebrand antigen (vWF:AG), and collagen-binding capacity (vWF: CB) were obtained. Von Willebrand factor (vWF) multimer analyses were performed, and patients were screened for bleeding events. This analysis was repeated after removal of the device for transplantation or recovery (n = 12) and after a median of 15.5 months in ongoing patients (n = 11). In all patients on devices, severe impairment of platelet aggregation as well as a loss of large vWF multimers were found. In 10 patients, a decreased vWF: CB/vWF:AG ratio was observed. Bleeding episodes occurred with an incidence of 0.17 per patient-year. After removal of the device, normal patterns of platelet aggregation, multimer analysis, and vWF: CB/vWF: AG ratio were recorded. In the second analysis of ongoing patients, impairment of platelet aggregation and loss of large vWF multimers were verified.Conclusions-A diagnosis of von Willebrand syndrome type 2 was established in all patients after LVAD implantation, and bleeding events confirmed this finding. Reversibility of this condition was found after removal of the device. (Circ Heart Fail.2010;3:675-681.)