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Early Postoperative Changes in Von Willebrand Factor Activity Are Associated With Future Bleeding and Stroke in HeartMate 3 Patients.
Jahangiri, Parsa; Veen, Kevin M; van Moort, Iris; Bunge, Jeroen H; Constantinescu, Alina; Sjatskig, Jelena; de Maat, Moniek; Kluin, Jolanda; Leebeek, Frank; Caliskan, Kadir.
Afiliação
  • Jahangiri P; From the Department of Cardiology.
  • Veen KM; Cardiothoracic Surgery.
  • van Moort I; Hematology.
  • Bunge JH; From the Department of Cardiology.
  • Constantinescu A; Intensive Care, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands.
  • Sjatskig J; From the Department of Cardiology.
  • de Maat M; Cardiothoracic Surgery.
  • Kluin J; Hematology.
  • Leebeek F; Cardiothoracic Surgery.
  • Caliskan K; Hematology.
ASAIO J ; 2024 Jun 18.
Article em En | MEDLINE | ID: mdl-38896804
ABSTRACT
Hemocompatibility-related adverse events (HRAEs), particularly gastrointestinal bleeding, remain a frequent complication after left ventricular assist device (LVAD) implantation. The current study sought to describe and analyze whether early (<60 days) postoperative von Willebrand factor (VWF) activity assays predict the risk of gastrointestinal bleeding and stroke. A prospective single-center study including 74 HeartMate 3 device recipients between 2016 and 2023 was undertaken. The postoperative trajectory of the VWF profile was analyzed using linear mixed-effect models and Cox models were used to quantify associations between an early postoperative dip (≤0.7) in VWF activity assay measurements and late outcomes. Preoperatively, the mean VWFActivity (Act)/Antigen (Ag) and VWFCollagen Binding (CB)/Ag ratios were 0.94 (95% confidence interval [CI] = 0.81-1.02) and 0.95 (95% CI = 0.80-1.03), respectively, decreasing to 0.66 (95% CI = 0.57-0.73) and 0.67 (95% CI = 0.58-0.74) within 40 days (p < 0.05). In patients with VWFCB/Ag and VWFAct/Ag ratios ≤0.7 significantly more gastrointestinal bleeding (hazard ratio [HR] 2.53; 95% CI = 1.1-5.8, and HR 3.7; 95% CI = 1.5-9.2, respectively) and hemorrhagic stroke events (HR 3.5; 95% CI = 1.6-7.6 and HR 4.9; 95% CI = 2.1-11.7, respectively) were observed throughout the entire late (>60 days) postoperative period. In patients with VWFAct/Ag ratio ≤0.7 less ischemic stroke events were observed (HR 0.11; 95% CI = 0.01-0.85). In conclusion, VWFAct/Ag and VWFCB/Ag ratios ≤0.7 in the early postoperative phase can be used as biomarkers to predict HRAEs during long-term LVAD support.

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article