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Analysis of platelet function during left ventricular support with the Incor and Excor system
Christian Etz1, Henryk Welp, Markus Rothenburger
1Department of Thoracic, University Hospital, Münster, Germany.
The Heart Surgery Forum
|April 1, 2005
Summary
Mechanical assist devices like the Incor and Excor left ventricular assist devices (LVADs) are increasingly used. Sequential platelet function analysis helps monitor antiplatelet drug efficacy but cannot fully prevent late thromboembolic events.
Area of Science:
- Cardiology
- Biomedical Engineering
- Hematology
Background:
- Mechanical assist devices, including the Incor and Excor left ventricular assist devices (LVADs), are vital for managing heart failure due to donor organ scarcity.
- Thromboembolism remains a significant challenge despite advancements in pump technology for LVADs.
Purpose of the Study:
- To evaluate the initial experience with sequential platelet function analysis in patients with Incor and Excor LVADs.
- To assess the utility of a specific platelet analyzing system for optimizing antiplatelet therapy (aspirin and clopidogrel).
Main Methods:
- A pilot study involving 13 patients (5-61 years) with acute or end-stage heart failure who received Incor or Excor LVADs.
- Implementation of an anticoagulation protocol (heparin, aspirin, clopidogrel) and close monitoring using a PAP platelet analyzer.
- Sequential analysis of platelet function to guide antiplatelet drug dosage.
Main Results:
- Initial platelet function was abnormal in 85% of patients.
- No early bleeding complications (<30 days) were observed post-implantation.
- Three patients experienced late thromboembolic events, including stroke and systemic embolism, over a cumulative follow-up of >4.8 years.
Conclusions:
- The PAP platelet analyzer is a cost-effective tool for monitoring aspirin and clopidogrel efficacy in LVAD patients.
- While effective for dose optimization, this monitoring approach does not eliminate the risk of late thromboembolic events.