title: Monitoring hemostasis parameters in left ventricular assist device recipients - a preliminary report.
abstract: BACKGROUND
  Mechanical circulatory support (MCS) therapy is associated with the improvement of long-term prognosis in patients with end-stage heart failure. For years it has been used as a bridge to transplant. However, more recently it is even being used as a destination therapy. Recently, clinicians have identified common MCS therapy-associated complications: pump thrombosis, bleeding, and hemolysis. These complications are very challenging with regard to both diagnosis and management.
  
  
  OBJECTIVE
  To determine time-dependant changes of selected hemostasis/coagulation parameters in patients with end-stage heart failure treated with MCS and antithrombotic therapy.
  
  
  METHODS
  Sixteen patients with end-stage heart failure on left ventricular assist device (LVAD) were followed for 6 weeks (six blood samples for each patient). Every week an extended hemostasis panel was assessed, including activated partial thromboplastin time, prothrombin time, international normalized ratio, von Willebrand factor (vWF) activity, factor VIII activity, fibrinogen level, D-dimer, platelet response to arachidonic acid (ASPI test) and adenosine diphosphate (ADP test), thrombin receptor activating peptide-6 (TRAP test) and collagen (COL test).
  
  
  RESULTS
  The study population comprised 16 men. The median time from LVAD implantation was 120 days (100-150 days). During the study period the D-dimer and fibrinogen concentrations were elevated but remained similar throughout all six measurements. Meanwhile factor VIII and vWF activities were elevated in the first two measurements and then subsequently declined. Inhibition of platelet aggregation was greater early after LVAD implantation. During subsequent weeks the inhibition of platelet aggregation was less pronounced. No patient developed any bleeding or thrombo-embolic event during the study period.
  
  
  CONCLUSIONS
  Patients on MCS therapy demonstrate significant time-dependant changes in hemostasis parameters (both in the coagulation system and platelet aggregation).
authors: 3 Department of Cardiology, Silesian Centre for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland.
authors: Bartosz
authors: B
authors: Hudzik
authors: Hemostasis Laboratory, Silesian Centre for Heart Disease, Zabrze, Poland.
authors: Jacek
authors: J
authors: Kaczmarski
authors: Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland.
authors: Jerzy
authors: J
authors: Pacholewicz
authors: Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland.
authors: Michał
authors: M
authors: Zakliczyński
authors: 3 Department of Cardiology, Silesian Centre for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland.
authors: Mariusz
authors: M
authors: Gąsior
authors: Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland.
authors: Marian
authors: M
authors: Zembala
keywords: bleeding; left ventricular assist device; mechanical circulatory support; thrombosis