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. 2016 Aug 2;16(1):155.
doi: 10.1186/s12872-016-0334-z.

Effects of HeartWare ventricular assist device on the von Willebrand factor: results of an academic Belgian center

Fatemeh Esmaeilzadeh  1 , Aurélien Wauters  2 , Walter Wijns  3 , Jean-François Argacha  4 , Philippe van de Borne  2
Affiliations

Effects of HeartWare ventricular assist device on the von Willebrand factor: results of an academic Belgian center

Fatemeh Esmaeilzadeh et al. BMC Cardiovasc Disord. .

Abstract

Background: Left Ventricular Assist Device (LVAD) is a promising therapy for patients with advanced heart failure (HF), but bleeding complications remain an important issue. Previous series show that acquired von Willebrand syndrome was present in up to 100 % of first generation LVAD recipients. We report the effects of new generation LVADs on vW factor (vWF) metabolism and activity in our center.

Methods: Fifteen LVAD recipients (HeartWare®, Framingham, MA, USA) were compared to 12 HF patients, matched for age and body mass index. vWF antigen and activity, as well as D-dimers, were measured on hemostasis analyzers. A vWF LVAD-induced alteration was evocated when the [vWF activity]/[vWF antigen] ratio was <0.6. ADAMTS13 and high molecular weight multimers of vWF were also assessed.

Results: LVAD recipients had similar levels of endothelial vWF production than the HF subjects (137 ± 14.5 vs. 147 ± 11.7 %; respectively, p = 0.611) but a decreased vWF activity (90 ± 11 vs. 132.6 ± 13 %; respectively, p = 0.017). [vWF activity]/[vWF antigen] ratio was 0.65 ± 0.02 in the LVAD recipients and 0.92 ± 0.06 in the subjects with HF (p = 0.001). ADAMTS13 activity was 80.3 ± 4.7 % in LVAD recipients and 96.2 ± 3.5 % in the HF patients (p = 0.016). LVAD patients disclosed markedly elevated D-dimers (3217.7 ± 735 vs. 680.6 ± 223.2 ng/mL FEU in the HF patients, p = 0.006). The LVAD patients experienced one major hemorrhagic event and one systemic thrombotic event during the median follow-up of 345 days.

Conclusions: LVAD recipients achieved a new hemostatic equilibrium characterized by infrequent major hemorrhagic and thrombotic events, despite a mildly impaired vWF function and a markedly enhanced thrombin formation.

Trial registration: ISRCTN39517567.

Keywords: ADAMTS13; Bleeding; HeartWare; Left ventricle assist device; von Willebrand factor.

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Figures

Fig. 1
Fig. 1
Individual measures of vWF activity (IU/dL), [vWF activity]/[vWF antigen] ratio, ADAMTS13 (%), D-dimers (ng/mL FEU) in the LVAD patients (open lozenges) and HF patients (closed circles) and their respective mean ± SEM values. *: p < 0.05, +: p = 0.001, number of measures seem less than actual because of overlapping individual values
Fig. 2
Fig. 2
vWF multimer analysis in a low resolution gel (1.2 % SDS-agarose). The large multimers are found in the upper part of the gel. Results obtained from normal pooled plasma are compared to those from the LVAD recipients with an AvWS (presented in the Discussion section) and a HF patient with normal vWF multimers
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