title: Severe upper gastrointestinal bleeding in Heartmate II induced by acquired von Willebrand deficiency: anticoagulation management.
abstract: Patients treated with continuous flow assist devices may have increased bleeding tendencies due to an induced high molecular weight von Willebrand factor (VWF) multimer deficiency. We report a patient supported with a HeartMate II (Thoratec, Pleasanton, CA) who developed severe gastrointestinal bleeding refractory to conventional therapy and needing a total of 60 transfusions. After documenting the lack of large VWF multimers, suggestive of a defective platelet function, the patient was switched from aspirin to warfarin therapy (target international normalized ratio between 1.5 and 2.0). Three days after changing the anticoagulant regimen, the patient stopped bleeding and required no further transfusion.
authors.affiliation: Québec Heart and Lung Institute, Québec City, Québec, Canada.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sponga
authors.forename: Chiara
authors.initials: C
authors.lastname: Nalli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casonato
authors.forename: Eric
authors.initials: E
authors.lastname: Charbonneau
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014859:Warfarin / Q000627:therapeutic use*; D014842:von Willebrand Diseases / Q000150:complications*
chemical_list: D000925:Anticoagulants; D014859:Warfarin