Acquired von Willebrand Syndrome in Continuous-Flow Ventricular Assist Device Recipients
Acquired von Willebrand Syndrome in Continuous-Flow Ventricular Assist Device Recipients
复制标题
DOI：
10.1016/j.athoracsur.2010.04.099
复制
发表时间：
2010-10-01
影响因子：
4.6
通讯作者：
Villamizar-Ortiz, Nestor
中科院分区：
文献类型：
--
作者：
Crow, Sheri;Chen, Dong;Villamizar-Ortiz, Nestor
背景资料。出血是持续血流左心室辅助装置(CF-LVAD)受者发病率的主要原因。为了建立更好的抗凝治疗策略和出血并发症的风险评估，有必要更好地了解CF-LVAD支持对止血谱的影响。本研究采用多中心前瞻性研究方法，对接受CF-LVAD植入术的患者的von Willebrand因子(VWF)进行分析。2008年7月至2009年4月，杜克大学和明尼苏达大学的37名患者在植入CF-LVAD前后采集了血样。分析血样中的vWF、血小板和胶原结合能力。凝胶电泳法检测到高相对分子质量(HMW)vWF多聚体的存在，缺失程度从0(正常)到3(严重缺失)。37例患者在植入CF-LVAD后30d内均表现出HMW vWF多聚体的显著丢失。37例患者中有10例发生了CF-LVAD置入术后出血并发症。所有接受CF-LVAD的患者在放置LVAD后都患上了von Willebrand综合征，表现为HMW vWF多聚体水平降低或缺失。然而，并不是所有的接受者都有出血并发症。这些发现表明，仅丢失HMW vWF多聚体并不能预测出血风险。需要进一步改进实验室技术和进行更大规模的随访，以确定CF-LVAD受者出血的危险因素。
Background. Bleeding is a major cause of morbidity in recipients of continuous-flow left ventricular assist devices (CF-LVAD). A better understanding of the impact of CF-LVAD support on the hemostatic profile is necessary to establish better strategies for anticoagulation therapy and risk assessment for bleeding complications. A prospective multicenter study was conducted to characterize von Willebrand factor (vWF) profiles in patients undergoing CF-LVAD implantation.Methods. Blood samples were collected before and after CF-LVAD implantation from 37 patients between July 2008 and April 2009 at Duke University and the University of Minnesota. Blood samples were analyzed for vWF, platelet and collagen-binding ability. The presence of high-molecular-weight (HMW) vWF multimers were detected through gel electrophoresis, and deficiency was graded on a scale of 0 (normal) to 3 (severe loss).Results. All 37 patients exhibited significant loss of HMW vWF multimers within 30 days of CF-LVAD implantation. Ten of the 37 patients experienced bleeding complications after CF-LVAD placement.Conclusions. All CF-LVAD recipients had acquired von Willebrand syndrome after LVAD placement, demonstrated by reduced or absent HMW vWF multimer levels. However, not all recipients had bleeding complications. These findings suggest that loss of HMW vWF multimers alone cannot predict bleeding risk. Further refinement of laboratory techniques and a larger follow-up is required to identify risk factors for bleeding in CF-LVAD recipients.