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In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
732
Enhanced Thrombin Formation in Patients With Ventricular Assist Devices Experiencing Bleeding: Insights From the
Walter Jeske1, John Ransom2, Jason N Katz3
1From the Loyola University Chicago, Maywood, Illinois.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|February 2, 2023
Summary
Left ventricular assist device (LVAD) patients show persistent thrombin activation, increasing bleeding risk. Elevated prothrombin fragment 1.2 (F1.2) levels post-LVAD implantation are linked to higher bleeding and gastrointestinal bleeding incidence.
Area of Science:
- Cardiology
- Hematology
- Biomedical Engineering
Background:
- Heart failure patients often require mechanical circulatory support with left ventricular assist devices (LVADs).
- Bleeding complications are a significant concern in patients with LVADs, despite standard anticoagulation therapies.
- Understanding the hemostatic status in LVAD patients is crucial for mitigating bleeding risks.
Purpose of the Study:
- To characterize the hemostatic status of patients implanted with LVADs.
- To identify hemostatic mechanisms associated with bleeding events in this population.
- To evaluate changes in thrombin and fibrinolytic activity before and after LVAD implantation.
Main Methods:
- Prospective enrollment of 300 heart failure patients undergoing LVAD implantation across 23 US hospitals (PREVENT study).
- Collection of serum and plasma samples from 175 patients at baseline and 3 months post-LVAD implantation.
- Measurement of thrombin markers (prothrombin fragment 1.2 [F1.2], thrombin generation [TG]) and fibrinolytic markers (D-dimer, plasminogen activator inhibitor-1 [PAI-1]).
Main Results:
- Pre-implant, heart failure patients exhibited elevated thrombin and fibrinolytic activity.
- Following LVAD implantation, F1.2, TG, and PAI-1 levels decreased, while D-dimer increased.
- Higher F1.2 levels at 3 months post-implant were significantly associated with increased incidence of late bleeding and gastrointestinal bleeding.
Conclusions:
- LVAD-implanted patients demonstrate persistent hemostatic activation, specifically excess thrombin formation, even with anticoagulation.
- Elevated prothrombin fragment 1.2 (F1.2) is a key indicator associated with increased bleeding risk, particularly gastrointestinal bleeding, in LVAD patients.
- These findings suggest that monitoring and potentially modulating thrombin generation could be vital for managing bleeding complications in LVAD recipients.
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