Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices

T. Spanier, M. Oz, H. Levin, A. Weinberg, K. Stamatis, David Stern, E. Rose, A. M. Schmidt

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Left ventricular assist devices have provided successful supportive therapy for patients awaiting cardiac transplantation for extended periods of time. Although thromboembolic events have complicated support with these devices, the HeartMate left ventricular assist device developed by Thermo Cardiosystems, Inc., Woburn, Massachusetts, was specifically designed with a textured blood-contacting surface to minimize this risk. Clinical experience with this device has been encouraging, inasmuch as minimal thromboembolic complications have occurred despite the absence of anticoagulation. The coagulation and fibrinolytic pathways in these individuals were investigated to better understand the hematologic status of patients treated with the Thermo Cardiosystems device. Despite apparently normal prothrombin and activated partial thromboplastin times, as well as platelet counts, evidence of significant thrombin generation and fibrinolysis was present. To eliminate underlying cardiac failure as the responsible factor for these abnormalities, we made similar measurements in patients with end-stage heart failure who were not supported by an assist device or anticoagulation. These measurements revealed no evidence of thrombin generation or fibrinolysis. These data demonstrate that patients supported with a left ventricular assist device, while successfully sustained without systemic anticoagulation, nevertheless have evidence of activation of coagulation. These phenomena appear to be related to the presence of the device rather than to the underlying cardiac abnormalities. Although procoagulant and fibrinolytic pathways are apparently balanced in these patients, these data underscore the potential for the development of bleeding or thrombosis in clinically relevant settings.

Original languageEnglish (US)
Pages (from-to)1090-1097
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume112
Issue number4
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

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Heart-Assist Devices
Equipment and Supplies
Fibrinolysis
Thrombin
Heart Failure
Partial Thromboplastin Time
Prothrombin
Heart Transplantation
Platelet Count
Thrombosis
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. / Spanier, T.; Oz, M.; Levin, H.; Weinberg, A.; Stamatis, K.; Stern, David; Rose, E.; Schmidt, A. M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 112, No. 4, 01.01.1996, p. 1090-1097.

Research output: Contribution to journalArticle

Spanier, T. ; Oz, M. ; Levin, H. ; Weinberg, A. ; Stamatis, K. ; Stern, David ; Rose, E. ; Schmidt, A. M. / Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. In: Journal of Thoracic and Cardiovascular Surgery. 1996 ; Vol. 112, No. 4. pp. 1090-1097.
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