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Updated: Sep 13, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Platelet derived prothrombotic microparticles and adverse events in patients supported with Impella 5.5
Nicoletta D'Ettore1, Alessandra Petruzza2, Astrid Cardinale3
1Department of Cardiology, San Giacomo Hospital, Novi Ligure, ASL Alessandria, Italy.
Abstract:
Platelet derived prothrombotic microparticles (MP) have been associated with hemocompatibility related adverse events in patients with continuous flow left ventricular assist devices; little is known with the contemporary Impella platform micro-axial flow pumps. Indeed, the extended duration of support provided by the Impella 5.5 calls for a specific evaluation. We report for the first time two patients in whom MP have been assessed during Impella 5.5 and concomitant dual antiplatelet and direct thrombin inhibitor therapy. Interestingly, the patients showed significantly different profile in overall MP release (peak: 78.1% vs 2.7%), which was not correlated to lactate dehydrogenase nor platelet count. The patient with the higher values suffered from minor stroke 4 days after pump removal, when systemic anticoagulation with Bivalirudin had been stopped. These preliminary data might envision a new predictor of hemocompatibility related adverse events in patients with Impella, and a rethinking on the post support antithrombotic strategy.
Insights
Platelet-derived microparticles (MP) may predict adverse events in Impella 5.5 pump patients. Different MP release profiles were observed, with one patient experiencing a stroke post-removal.
Area of Science:
- Cardiology
- Biomedical Engineering
- Hematology
Background:
- Platelet-derived microparticles (MP) are linked to adverse events in left ventricular assist device (LVAD) patients.
- Limited data exists on MP profiles with the Impella 5.5 micro-axial flow pump, especially for extended support durations.
Purpose of the Study:
- To assess microparticle release in patients supported by the Impella 5.5 pump.
- To evaluate the relationship between MP levels and hemocompatibility during dual antiplatelet and direct thrombin inhibitor therapy.
Main Methods:
- Case report of two patients undergoing Impella 5.5 support.
- Assessment of platelet-derived microparticle release.
- Monitoring of lactate dehydrogenase and platelet counts.
Main Results:
- Significant differences in overall MP release were observed between the two patients (peak: 78.1% vs 2.7%).
- MP release did not correlate with lactate dehydrogenase levels or platelet counts.
- The patient with higher MP release experienced a minor stroke after pump removal and cessation of anticoagulation.
Conclusions:
- Preliminary data suggests MP release may be a novel predictor of hemocompatibility-related adverse events in Impella 5.5 patients.
- Findings may necessitate a re-evaluation of antithrombotic strategies post-Impella support.
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