Left Ventricular Assist Device-Induced Coagulation and Platelet Activation and Effect of the Current Anticoagulant Therapy Regimen
Left Ventricular Assist Device-Induced Coagulation and Platelet Activation and Effect of the Current Anticoagulant Therapy Regimen
复制标题
DOI：
10.1177/1076029612464900
复制
发表时间：
2013-06-01
影响因子：
2.9
通讯作者：
Bakhos, Mamdouh
中科院分区：
文献类型：
--
作者：
Ashbrook, Michael;Walenga, Jeanine M.;Bakhos, Mamdouh
左心室辅助装置（LVAD）是增强心力衰竭患者心脏功能的机械泵。总之，7例LVAD患者（1.8国际标准化比值华法林，81 mg阿司匹林）每月评价一次血小板和凝血活化，持续3个月（对照组：5例健康成人和5例华法林患者）。血小板工作显示LVAD对胶原蛋白（31.8% vs 7.9%; P = 0.004）、花生四烯酸（30.9% vs 8.2%; P = 0.001）和二磷酸腺苷（10.9% vs 6.1%; P = 0.004）诱导的血小板聚集的抑制作用更大。血栓弹力图（抗凝全血）显示凝块起始时间受到抑制（R; 8.81 vs 6.02 min; P = 0.001）和更强的凝块形成（最大振幅; 69.1 vs 64.9 mm; P = 0.016）。血小板图和流式细胞术测定的血小板功能在正常范围内。LVAD的血管性血友病因子（vWF）抗原和vWF前肽的比例增加，表明vWF降解增加（2.04 vs 1.44; P = 0.144）。药物治疗可抑制LVAD引起的凝血和血小板活化，其特征与单独使用华法林的患者相似。
Left ventricular assist devices (LVADs) are mechanical pumps that enhance cardiac function in patients with heart failure. In all, 7 patients with an LVADs (1.8 international normalized ratio warfarin, 81 mg aspirin) were evaluated monthly for 3 months for platelet and coagulation activation (controls: 5 healthy adults and 5 patients having warfarin). Platelet works revealed greater inhibition of collagen (31.8% vs 7.9%; P = .004), arachidonate- (30.9% vs 8.2%; P = .001), and adenosine diphosphate- (10.9% vs 6.1%; P = .004)-induced platelet aggregation for LVADs. Thrombelastography (recalcified whole blood) showed inhibition of clot initiation time (R; 8.81 vs 6.02 min; P = .001) and stronger clot formation (maximum amplitude; 69.1 vs 64.9 mm; P = .016). Platelet function determined by plateletMapping and flow cytometry was within the normal range. The LVADs had increased ratio of von Willebrand Factor (vWF) antigen and vWF propeptide, indicating increased degradation of vWF (2.04 vs 1.44; P = .144). Coagulation and platelet activation caused by LVAD is suppressed by pharmacotherapy, yielding a profile similar to that of patients on warfarin alone.