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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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Device-Induced Hemostatic Disorders in Mechanically Assisted Circulation.

Shigang Wang1, Bartley P Griffith1, Zhongjun J Wu1,2

  • 1Department of Surgery, 12264University of Maryland School of Medicine, Baltimore, MD, USA.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|February 11, 2021
PubMed
Summary

Mechanically assisted circulation (MAC) causes blood damage via non-physiological shear stress (NPSS). This review details NPSS effects on blood cells, impacting patient outcomes in cardiac surgery and VAD/ECMO support.

Keywords:
cardiopulmonary bypassextracorporeal membrane oxygenationhemostatic disordermechanical shear stressventricular assist device

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Area of Science:

  • Biomedical Engineering
  • Hematology
  • Cardiovascular Research

Background:

  • Mechanically assisted circulation (MAC) supports patients during cardiac surgery (CPB), ventricular assistance (VAD), or extracorporeal membrane oxygenation (ECMO).
  • Blood exposure to non-physiological shear stress (NPSS) and artificial surfaces during MAC causes cellular damage and functional alterations.
  • These blood alterations are linked to adverse clinical events, including bleeding, thrombosis, and mortality.

Purpose of the Study:

  • To review the mechanisms of shear-induced hemostatic disorders in patients undergoing MAC.
  • To elucidate the impact of NPSS on blood components, particularly platelets and red blood cells.
  • To highlight the association between shear-induced blood damage and clinical outcomes in MAC patients.

Main Methods:

  • Literature review of studies investigating blood-material interactions and shear stress effects in MAC.
  • Analysis of mechanisms underlying platelet activation, aggregation, shedding, and apoptosis.
  • Examination of shear-induced acquired von Willebrand syndrome (AVWS), hemolysis, and microparticle formation.

Main Results:

  • NPSS induces platelet adhesion, aggregation, receptor shedding, and apoptosis.
  • Shear stress leads to acquired von Willebrand syndrome (AVWS), hemolysis, and the formation of blood microparticles.
  • These hematological changes correlate with perioperative bleeding, thrombotic complications, and patient mortality.

Conclusions:

  • Understanding shear-induced hemostatic disorders is crucial for improving patient care during MAC.
  • Development of low-shear-stress devices is essential for mitigating blood damage.
  • Targeted treatments informed by NPSS mechanisms can enhance clinical outcomes and quality of life for MAC patients.