title: Bleeding and thrombosis in chronic ventricular assist device therapy: focus on platelets.
abstract: OBJECTIVE
  Left ventricular assist devices (LVADs) have markedly improved the survival for patients with advanced heart failure but are plagued with significant morbidity, including pump thrombosis and bleeding. Better understanding of the platelet, and its role in the balance of bleeding and thrombosis, stands to impact the frequency and treatment of these significant complications.
  
  
  RESULTS
  In patients with LVADs, there is little consistency linking traditional biomarkers of platelet activation and clinical events. A number of innovative methods of assessing platelet functionality, including shedding of platelet receptors and formation of microparticle complexes as well as measuring mitochondrial membrane potentials, exist and appear to be clinically relevant. Acquired von Willebrand syndrome, while not explaining all bleeding events, is a central feature of mechanical support and offers a target for innovative therapies.
  
  
  CONCLUSIONS
  Although the platelet is only one component of impacting thrombosis and bleeding in patients supported with LVADs, it plays a central role in mediating these two opposing forces. Innovations in understanding platelet physiology as well as manipulating genomic and receptor interactions for an individual patient will be critical if we are to decrease these serious adverse events in the future.
authors.affiliation: aDivision of Cardiothoracic SurgerybDepartment of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
authors.forename: Antigone
authors.initials: A
authors.lastname: Koliopoulou
authors.forename: Stephen H
authors.initials: SH
authors.lastname: McKellar
authors.forename: Matthew
authors.initials: M
authors.lastname: Rondina
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
mesh_terms: D001792:Blood Platelets / Q000502:physiology*; D055252:Cell-Derived Microparticles / Q000502:physiology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015539:Platelet Activation; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control; D014842:von Willebrand Diseases / Q000209:etiology