title: Increased carbon monoxide production by hemeoxygenase-1 caused by device-mediated hemolysis: thrombotic phantom menace?
abstract: Replacement of key components of the circulatory system with artificial devices has become the mainstay of therapy for conditions such as end-stage valvular disease or congestive heart failure. Unfortunately, device thrombosis and thromboembolic morbidity persist despite optimized anticoagulation. This work reviews the commonly known causes of device-associated thrombophilia, introduces recent literature concerning the effect of carbon monoxide on coagulation, and presents new patient data linking endogenously produced carbon monoxide with device-associated thrombosis. A new paradigm involving the interaction of red blood cell lysis-induced upregulation of hemoxygenase-1, increased endogenous carbon monoxide, hyperfibrinogenemia, and contact protein/microparticle-induced thrombin generation is presented.
authors.affiliation: Department of Anesthesiology, The University of Arizona College of Medicine, Tucson, AZ, USA.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Nielsen
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Pearson
authors.forename: M Cristina
authors.initials: MC
authors.lastname: Smith
mesh_terms: D000818:Animals; D001777:Blood Coagulation; D002248:Carbon Monoxide / Q000378:metabolism*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D051547:Heme Oxygenase-1 / Q000378:metabolism*; D006461:Hemolysis; D006801:Humans; D013927:Thrombosis / Q000209:etiology* / Q000378:metabolism
chemical_list: D002248:Carbon Monoxide; D051547:Heme Oxygenase-1
keywords: Carbon monoxide; Hemeoxygenase-1; Hemolysis; Prosthetic heart valve; Thromboembolism; Total artificial heart; Ventricular assist device