Platelet microRNA Expression Can Predict Bleeding in HeartMate3 Patients Treated With or Without Aspirin

We tested whether platelet microRNAs (miRs) expression can predict bleeding in patients supported with the HeartMate3 (HM3) left ventricular assist device (LVAD). The levels of expression of platelet miR-126, miR-233, miR-151a, and miR-454 were prospectively measured in 12 consecutive patients pre-implant and during long-term follow-up and compared based on aspirin (ASA) or ASA-free therapy at discharge and bleeding events over the course of HM3 support. Median time of follow-up was 760 (574-844) days. Seven (58%) patients were discharged on ASA and 5 (42%) without ASA. Three (25%) patients experienced 10 bleeding episodes: one never received ASA, and two suffered from bleeding recurrency long after permanent ASA discontinuation. ASA had minimal influence on platelet miRs expression. The expression levels of platelet miR-454 were lower in bleeders vs. non-bleeders, both pre-implant and post-implant. This study suggests the existence of a patient-specific pro-hemorrhagic phenotype associated with a distinctive expression profile of platelet miR-454. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03255928 . ClinicalTrials.gov Identifier: NCT03255928.