PMID- 29282819 OWN - NLM STAT- MEDLINE DCOM- 20190102 LR - 20190102 IS - 1879-0844 (Electronic) IS - 1388-9842 (Linking) VI - 20 IP - 4 DP - 2018 Apr TI - Platelet activation is a preoperative risk factor for the development of thromboembolic complications in patients with continuous-flow left ventricular assist device. PG - 792-800 LID - 10.1002/ejhf.1113 [doi] AB - AIMS: To correlate the dynamics of platelet activation with the development of thromboembolic events in patients with continuous-flow left ventricular assist device (cf-LVAD). METHODS AND RESULTS: The platelet activity state (PAS) assay was utilized to evaluate platelet activation in 68 cf-LVAD patients implanted with the HeartMate II (n = 15, 22%), HeartMate 3 (n = 15, 22%), or HeartWare HVAD (n = 38, 56%). PAS was measured preoperatively, early post-implant, and at long-term follow-up (1, 3, 6, 12, 18, and 24 months post-implant). PAS was also measured at the occurrence of adverse events in patients who developed thrombotic complications. Data on patient demographics, medical history, antithrombotic therapy, and coagulation parameters were also analysed. Over a median follow-up of 602 (234-942) days, PAS values did not increase over time in the overall population (P = 0.15). However, PAS measured at event was 15-fold higher in the six patients (9%) who suffered pump thrombosis (n = 2) or ischaemic stroke (n = 4) vs. the rest of the population [6.67% (5.59%-11.98%) vs. 0.45% (0.33%-0.75%); P = 0.012], despite comparable coagulation profile. Pre-implant PAS values were 4.5-fold higher in these patients [1.90% (1.24%-3.17%) vs. 0.42% (0.32%-0.72%); P = 0.006]. Neither preoperative variables nor the type of the pump or the antiplatelet strategy were associated with a higher risk of complications. CONCLUSIONS: Thrombotic events are associated with altered PAS values. Moreover, baseline elevated PAS values in patients who developed thrombotic events suggest patient-specific tendency to post-implant thromboembolic complications. Prospectively, systematic monitoring of PAS might guide the development of refined patient-tailored antithrombotic strategies and the technological improvement of LVAD design. CI - (c) 2017 The Authors. European Journal of Heart Failure (c) 2017 European Society of Cardiology. FAU - Consolo, Filippo AU - Consolo F AD - Universita Vita Salute San Raffaele, Milan, Italy. AD - Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. FAU - Sferrazza, Giulia AU - Sferrazza G AD - Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. AD - Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milan, Italy. FAU - Motolone, Giulia AU - Motolone G AD - Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. AD - Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milan, Italy. FAU - Contri, Rachele AU - Contri R AD - Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milan, Italy. FAU - Valerio, Lorenzo AU - Valerio L AD - Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. AD - Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milan, Italy. FAU - Lembo, Rosalba AU - Lembo R AD - Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milan, Italy. FAU - Pozzi, Loris AU - Pozzi L AD - Coagulation Service and Thrombosis Research Unit, San Raffaele Scientific Institute, Milan, Italy. FAU - Della Valle, Patrizia AU - Della Valle P AD - Coagulation Service and Thrombosis Research Unit, San Raffaele Scientific Institute, Milan, Italy. FAU - De Bonis, Michele AU - De Bonis M AD - Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy. FAU - Zangrillo, Alberto AU - Zangrillo A AD - Universita Vita Salute San Raffaele, Milan, Italy. AD - Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milan, Italy. FAU - Fiore, Gianfranco B AU - Fiore GB AD - Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. FAU - Redaelli, Alberto AU - Redaelli A AD - Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. FAU - Slepian, Marvin J AU - Slepian MJ AD - Department of Medicine and Biomedical Engineering, Sarver Heart Center, The University of Arizona, Tucson, AZ, USA. FAU - Pappalardo, Federico AU - Pappalardo F AD - Universita Vita Salute San Raffaele, Milan, Italy. AD - Anesthesia and Cardiothoracic Intensive Care, San Raffaele Scientific Institute, Milan, Italy. LA - eng GR - U01 EB012487/EB/NIBIB NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20171228 PL - England TA - Eur J Heart Fail JT - European journal of heart failure JID - 100887595 RN - 0 (Biomarkers) SB - IM CIN - Eur J Heart Fail. 2018 Apr;20(4):801-802. PMID: 29388294 MH - Aged MH - Biomarkers/blood MH - Blood Platelets/*physiology MH - Cross-Sectional Studies MH - Female MH - Follow-Up Studies MH - Heart Failure/blood/*therapy MH - Heart-Assist Devices/*adverse effects MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Platelet Activation/*physiology MH - *Postoperative Complications MH - Prognosis MH - Retrospective Studies MH - Thromboembolism/*blood/epidemiology/etiology OTO - NOTNLM OT - Antithrombotic therapy OT - Left ventricular assist device OT - Platelet activation OT - Platelet activity state assay OT - Thrombotic risk EDAT- 2017/12/29 06:00 MHDA- 2019/01/03 06:00 CRDT- 2017/12/29 06:00 PHST- 2017/08/08 00:00 [received] PHST- 2017/10/23 00:00 [revised] PHST- 2017/11/20 00:00 [accepted] PHST- 2017/12/29 06:00 [pubmed] PHST- 2019/01/03 06:00 [medline] PHST- 2017/12/29 06:00 [entrez] AID - 10.1002/ejhf.1113 [doi] PST - ppublish SO - Eur J Heart Fail. 2018 Apr;20(4):792-800. doi: 10.1002/ejhf.1113. Epub 2017 Dec 28.