title: Hemorrhage and thrombosis with different LVAD technologies: a matter of flow?
abstract: BACKGROUND
  Much of the morbidity and mortality associated with ventricular assist devices (VADs) is due to haemorrhagic and thrombotic complications. To manage antithrombotic therapy, interactions between the patient and pump should be better understood.
  
  
  METHODS
  We have compared the Jarvik 2000, an axial flow left ventricular assist device (LVAD), with the HeartWare ventricular assist device (HVAD) centrifugal pump, regarding conventional laboratory findings, thromboelastometric and aggregometric tests.
  
  
  RESULTS
  Patients with the Jarvik 2000 experienced a significant reduction in platelet count following implantation, a phenomenon not seen with the HeartWare model. Conversely, we observed that levels of platelet activation, as assessed by a platelet function analyzer, and activation of the coagulation system, as assessed by thromboelastometry, were significantly greater in the HeartWare group.
  
  
  CONCLUSIONS
  It seems that axial flow pumps, being more destructive on blood cells, tend to reduce platelet numbers. On the other hand, centrifugal flow is associated with a hypercoagulable state, possibly resulting from the activation of the coagulation system in the absence of platelet destruction.
authors.affiliation: 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tarzia
authors.affiliation: 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Edward
authors.initials: E
authors.lastname: Buratto
authors.affiliation: 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bortolussi
authors.affiliation: 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Michele
authors.initials: M
authors.lastname: Gallo
authors.affiliation: 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Jonida
authors.initials: J
authors.lastname: Bejko
authors.affiliation: 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bianco
authors.affiliation: 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Tomaso
authors.initials: T
authors.lastname: Bottio
authors.affiliation: 1 Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy ; 2 Cardiac Surgery Unit, Department of Paediatrics, University of Melbourne, Melbourne, Australia.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
keywords: Ventricular assist device (VAD); axial flow; bleeding; centrifugal flow; thrombosis