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Thromboembolic Events in Patients With Left Ventricular Assist Devices Are Related to Microparticle-Induced

Nicolas Kramser1, Daniel Oehler1, Diyar Saeed2

  • 1From the Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|December 21, 2020
PubMed

Insights

Left ventricular assist device (LVAD) implantation increases circulating microparticles (MPs) and MP-induced coagulation, raising the risk of thromboembolic events (TEs). Elevated platelet MPs and thrombin formation predict TEs in LVAD patients.

Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Biomedical Engineering

Background:

  • Thromboembolic events (TEs) are a significant risk for patients with continuous-flow left ventricular assist devices (LVADs).
  • The precise mechanisms linking LVAD support to TEs, particularly the role of circulating microparticles (MPs) in coagulation activation, require further elucidation.

Purpose of the Study:

  • To investigate the impact of LVAD implantation on endothelial function, circulating MPs (endothelial MPs [EMPs] and platelet MPs [PMPs]), and MP-induced procoagulative activity.
  • To determine if these parameters predict the occurrence of TEs in patients with LVAD support.

Main Methods:

  • Analysis of endothelial function (flow-mediated vasodilation), EMPs, PMPs, and MP-induced thrombin formation in 15 patients before, immediately after, and 3 months post-LVAD implantation.
  • Prospective follow-up of 43 LVAD patients for 12 months to assess the incidence of TEs and correlate it with pre- and post-implantation MP levels and coagulation activity.

Main Results:

  • LVAD implantation led to decreased flow-mediated vasodilation, increased EMP levels, and elevated PMP levels and MP-induced thrombin formation.
  • In patients with ongoing LVAD support, higher levels of PMPs and MP-induced thrombin formation were observed in those who experienced TEs compared to those who did not.
  • Elevated PMPs and MP-induced thrombin formation were identified as independent predictors of TEs in LVAD patients.

Conclusions:

  • LVAD implantation enhances MP-induced coagulation, which is independently associated with an increased risk of TEs.
  • Circulating MPs and their procoagulative activity may serve as valuable biomarkers for risk stratification in LVAD patients.
  • These findings suggest potential for individualized therapeutic modifications to mitigate TE risk in LVAD therapy.

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