title: Pediatric Acquired von Willebrand Disease With Berlin Heart Excor Ventricular Assist Device Support.
abstract: The balance of hemostasis and anticoagulation is a concern for patients dependent upon ventricular assist devices (VADs). Bleeding is a common complication with both short- and long-term use of these devices. A better understanding of the risk factors and etiologies of bleeding associated with these devices is needed and could improve the overall results. We sought to determine the relationship of mechanical circulatory assist device use with acquired von Willebrand disease (avWD) in children.
  
  
  
  Data were analyzed retrospectively via review of the medical record of 19 consecutive patients who were supported with the Berlin EXCOR VAD for greater than 24 hours. Laboratory testing for avWD was performed at the discretion of the clinical team, often in association with clinical bleeding.
  
  
  
  Of 19 pediatric patients, 10 (52.6%) had laboratory testing consistent with avWD. Median time to detection of avWD was 35 days postimplantation of device (range 0-310 days). Both minor mucosal bleeding and bleeding requiring intervention were highly prevalent in patients in whom avWD was identified (10/10 [100%] and 7/10 [70%]). The mean age of all patients was 3.3 years, but patients found to have avWD tended to be older (mean 5.3 years) and supported with larger volume VADs.
  
  
  
  This experience demonstrates a high prevalence of avWD following EXCOR implantation. Bleeding, older age, and larger VAD size may be associated with avWD. These results should stimulate critical evaluation of individualized anticoagulation regimens in pediatric VAD patients.
authors: Division of Pediatric Hematology and Oncology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
authors: Nathan
authors: N
authors: Gossai
authors: Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA.
authors: Nicholas M
authors: NM
authors: Brown
authors: Division of Pediatric Cardiology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.
authors: Rebecca
authors: R
authors: Ameduri
authors: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
authors: Nicole D
authors: ND
authors: Zantek
authors: Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors: James St
authors: JS
authors: Louis
authors: Division of Pediatric Hematology and Oncology, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA stein083@umn.edu.
authors: Marie E
authors: ME
authors: Steiner
mesh_terms: D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014842:von Willebrand Diseases / Q000150:complications* / Q000453:epidemiology
keywords: bleeding; circulatory support devices; heart failure; heart transplantation