title: Platelet activation in heart failure patients supported by the HeartMate II ventricular assist device.
abstract: OBJECTIVE
  Thromboembolic events have been observed in heart failure (HF) patients supported by long-term mechanical circulatory support (MCS) devices. It has been hypothesized that these adverse events may be the result of platelet activation associated with high rotational speeds common to axial flow pumps. In this study, markers of platelet activation were investigated in HF patients supported by a HeartMate II left ventricular assist device (LVAD).
  
  
  METHODS
  The study group consisted of 34 HF patients supported by a HeartMate II axial flow LVAD implanted for destination therapy (DT). This patient population was 94% male (31 M, 3 F), supported by LVAD for 30 to 723 days (average 268 days), and with an anticoagulation regimen of Coumadin (0-8 mg daily dose) and aspirin (0-325 mg daily dose). Platelet adhesion markers (soluble P-selectin and solube CD40 ligand), platelet count (PC), hematocrit (Hct), and creatinine (Cr) were measured.
  
  
  RESULTS
  The soluble P-selectin marker was within normal platelet activity limits for all end points. The soluble CD40 ligand marker indicated platelet inactivity for all end points. Despite high shear stresses associated with a high-speed axial flow pump, the HeartMate II had no discernable effect on platelet activation. Current clinical doses of aspirin also appear to have little effect on platelet activation. Platelet count, hematocrit, and creatinine were normal in these patients over duration of support.
  
  
  CONCLUSIONS
  There were no discernable changes in platelet activation markers soluble P-selectin and soluble CD40 ligand in HF patients support by HeartMate II LVAD independently of length of support, anti-platelet, and anti-coagulation regimens.
authors: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, Louisville, KY 40202, USA. mark.slaughter@louisville.edu
authors: Mark S
authors: MS
authors: Slaughter
authors: Michael A
authors: MA
authors: Sobieski
authors: Joel D
authors: JD
authors: Graham
authors: Patroklos S
authors: PS
authors: Pappas
authors: Antone J
authors: AJ
authors: Tatooles
authors: Steven C
authors: SC
authors: Koenig
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D023201:CD40 Ligand / Q000097:blood; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006400:Hematocrit; D006461:Hemolysis; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D015539:Platelet Activation / Q000187:drug effects; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010976:Platelet Count; D011474:Prosthesis Design; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D019007:P-Selectin; D010975:Platelet Aggregation Inhibitors; C546937:SELP protein, human; D023201:CD40 Ligand; D014859:Warfarin; D003404:Creatinine; D001241:Aspirin