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Vitamin K reduces bleeding in left ventricular assist device recipients
R J Kaplon1, A M Gillinov, N G Smedira
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
Summary
Perioperative vitamin K administration significantly reduced postoperative bleeding in left ventricular assist device (LVAD) recipients. This intervention improved coagulation profiles, mitigating bleeding complications common in LVAD patients.
Area of Science:
- Cardiology
- Hematology
- Surgical Complications
Background:
- Left ventricular assist device (LVAD) recipients frequently experience bleeding complications despite design advancements.
- Pre-operative right ventricular failure and hepatic dysfunction may contribute to this bleeding diathesis.
Purpose of the Study:
- To characterize coagulation abnormalities in LVAD recipients.
- To evaluate the impact of pre-operative vitamin K on postoperative bleeding incidence.
Main Methods:
- Assessed hemostatic and liver function profiles in 66 Heartmate LVAD recipients.
- Administered perioperative vitamin K to 39 patients.
Main Results:
- LVAD support improved hepatic synthetic function, increasing clotting factors II, V, VII, and XI.
- Ongoing fibrinolysis was observed, but systemic disseminated intravascular coagulation (DIC) was not indicated.
- Patients receiving vitamin K had significantly lower rates of re-exploration for bleeding (5.1%) compared to those not receiving it (25.9%).
Conclusions:
- Liver synthetic function improves during LVAD support, enhancing coagulation factor levels.
- Fibrinolysis during LVAD support likely relates to fibrin remodeling on the device surface.
- Perioperative vitamin K effectively reduces nonsurgical bleeding in LVAD recipients.