Impact of loss of high-molecular-weight von Willebrand factor multimers on blood loss after aortic valve replacement
Impact of loss of high-molecular-weight von Willebrand factor multimers on blood loss after aortic valve replacement
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DOI：
10.1093/bja/aer512
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发表时间：
2012-05-01
影响因子：
9.8
通讯作者：
Filipovic, M.
中科院分区：
文献类型：
--
作者：
Bolliger, D.;Dell-Kuster, S.;Filipovic, M.
严重的主动脉瓣狭窄与最大的血管性血友病因子 (vWF) 多聚体的丢失有关，这可能会影响主要止血。我们假设多聚体结构的改变以及最大多聚体的丢失会增加接受主动脉瓣置换术的患者术后出血。我们前瞻性地纳入了 60 名患有严重主动脉瓣狭窄的受试者。主动脉瓣置换术前后，测定 vWF 抗原、活性和多聚体结构，并通过阻抗聚集法测量血小板功能。围手术期评估纵隔引流造成的失血以及血液和止血产品的使用。手术前，48 名受试者 (80) 中存在改变的多聚体结构。所有受试者的基线特征和实验室数据相似。 6小时后，多聚体结构改变组和正常组的中位失血量分别为250（105400）和145（85240）ml（P0.182）。 24小时后，多聚体结构改变组和正常组的累积损失分别为495（270650）和375（310600）ml（P0.713）。多变量分析显示多聚体结构和血小板功能对 6 小时和 24 小时后出血量没有显着影响。 24小时后，术前有和没有多聚体结构改变的受试者以及围术期输注和没有血浆输注的受试者中vWF抗原、活性和多聚体结构没有明显差异。术前vWF多聚体结构的改变与主动脉瓣置换术后出血增加无关。我们的研究结果可能可以通过围手术期 vWF 的释放和最大 vWF 多聚体的快速恢复来解释。
Severe aortic stenosis is associated with loss of the largest von Willebrand factor (vWF) multimers, which could affect primary haemostasis. We hypothesized that the altered multimer structure with the loss of the largest multimers increases postoperative bleeding in patients undergoing aortic valve replacement.We prospectively included 60 subjects with severe aortic stenosis. Before and after aortic valve replacement, vWF antigen, activity, and multimer structure were determined and platelet function was measured by impedance aggregometry. Blood loss from mediastinal drainage and the use of blood and haemostatic products were evaluated perioperatively.Before operation, the altered multimer structure was present in 48 subjects (80). Baseline characteristics and laboratory data were similar in all subjects. The median blood loss after 6 h was 250 (105400) and 145 (85240) ml in the groups with the altered and normal multimer structures, respectively (P0.182). After 24 h, the cumulative loss was 495 (270650) and 375 (310600) ml in the groups with the altered and normal multimer structures, respectively (P0.713). Multivariable analysis revealed no significant influence of multimer structure and platelet function on bleeding volumes after 6 and 24 h. After 24 h, there was no obvious difference in vWF antigen, activity, and multimer structure in subjects with and without the altered multimer structure before operation or in subjects with and without perioperative plasma transfusion.The altered vWF multimer structure before operation was not associated with increased bleeding after aortic valve replacement. Our findings might be explained by perioperative release of vWF and rapid recovery of the largest vWF multimers.