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Survival of HeartMate II Patients Despite Cessation of Anticoagulation ― Outcomes and Hemostatic Analysis ―
- Source :
- Circulation Journal. 82:1309-1318
- Publication Year :
- 2018
- Publisher :
- Japanese Circulation Society, 2018.
-
Abstract
- BACKGROUND In long-term left ventricular assist device (LVAD) therapy, recurrent bleeding events may justify cessation of anticoagulation therapy (AT). However, data about THE safety and risks of AT cessation in LVAD patients are scarce.Methods and Results:Between 2010 and 2015, 128 patients received a HeartMate II (HMII). Following recurrent bleeding events, we ceased vitamin K antagonist (VKA) therapy in 13 patients (10%) (no-VKA group). To characterize the hemostatic profile, we performed von Willebrand factor (vWF), platelet function (PF), and other hemostatic tests in all HMII patients. The incidence of pump thrombosis (PT), ischemic stroke (IS) and bleeding events in this HMII population was 4.7 %, 6.2% and 36.7%, respectively. Median survival without VKA was 435 days. No cases of PT and only 1 of IS occurred after AT discontinuation. All patients had impaired PF and acquired von Willebrand syndrome (AvWS). However, the vWF collagen-binding activity to antigen ratio before and after VKA cessation was significantly lower in the no-VKA group compared with the HMII population (0.60±0.12 vs. 0.73±0.14, P=0.006). The thrombin-antithrombin III complex (TAT) value was significantly higher in the no-VKA group (P=0.0005). CONCLUSIONS We experienced good results with AT cessation in specific HMII patients. The simultaneous onset of AvWS and high TAT values could explain at least in part the low thromboembolic rate in HMII patients without VKA.
- Subjects :
- Male
medicine.medical_specialty
medicine.drug_class
medicine.medical_treatment
Population
Hemorrhage
030204 cardiovascular system & hematology
Brain Ischemia
Prosthesis Implantation
03 medical and health sciences
0302 clinical medicine
Von Willebrand factor
Thromboembolism
Internal medicine
von Willebrand Factor
medicine
Humans
Platelet
Prospective Studies
education
Aged
Retrospective Studies
Hemostasis
education.field_of_study
Heartmate ii
biology
business.industry
Incidence
Incidence (epidemiology)
Anticoagulants
General Medicine
Middle Aged
Vitamin K antagonist
Discontinuation
Stroke
von Willebrand Diseases
030228 respiratory system
Ventricular assist device
Cardiology
biology.protein
Female
Heart-Assist Devices
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 13474820 and 13469843
- Volume :
- 82
- Database :
- OpenAIRE
- Journal :
- Circulation Journal
- Accession number :
- edsair.doi.dedup.....5aa450ef8a9a43b12a0dfbed75ce8cdf