Potapov Evgenij V, Ignatenko Stanislav, Nasseri Boris A, Loebe Matthias, Harke Cornelia, Bettmann Martin, Doller Anke, Regitz-Zagrosek Vera, Hetzer Roland
Departments of Cardiothoracic and Vascular Surgery, Berlin, Germany.
Ann Thorac Surg. 2004 Mar;77(3):869-74; discussion 874. doi: 10.1016/j.athoracsur.2003.08.013.
Although bleeding and thromboembolism remain major complications after implantation of ventricular assist devices (VADs), no standard anticoagulation protocols are available. Genetic polymorphism of platelet glycoprotein IIb/IIIa may contribute to the development of complications. The present study demonstrates a relationship between the PlA genotype and postoperative complications in patients implanted with pulsatile and axial flow VADs.
The PlA genotype was determined in 41 consecutive patients treated with a VAD who received anticoagulation with phenprocoumon and aspirin. Pulsatile Novacor (Novacor Corp, Oakland, CA) and Berlin Heart VADs (Berlin Heart, Berlin, Germany) were implanted in 28 patients and the axial flow MicroMed DeBakey VAD (MicroMed Technology, Inc, Houston, TX) in 13. The relationship between the PlA genotype, the anticoagulation regime, and bleeding and thromboembolic events was analyzed.
There were no differences between patients with the A1A1 and A1A2 genotype regarding demographic characteristics, weight, or infection episodes. The international normalized ratio (INR), platelet activation tests, and doses of aspirin and dipyridamol before events were similar in both groups. Patients with the A1A1 genotype developed more bleeding complications (39% vs 0%, p = 0.021), while patients with the A1A2 genotype showed a tendency toward more thromboembolic events (13% vs 30%, p = 0.33). With regard to different types of VAD, patients with the axial flow DeBakey VAD and the A1A1 genotype developed significantly more bleeding complications (70% vs 0%, p = 0.033).
In patients with a long-term VAD determination of PlA polymorphism and subsequent adjustment of the anticoagulation regime may lead to a reduction of bleeding and thromboembolic complications.
尽管出血和血栓栓塞仍然是心室辅助装置（VAD）植入后的主要并发症，但目前尚无标准的抗凝方案。血小板糖蛋白IIb/IIIa的基因多态性可能导致并发症的发生。本研究证实了接受搏动流和轴流VAD植入患者的PlA基因型与术后并发症之间的关系。
对41例接受VAD治疗并使用苯丙香豆素和阿司匹林抗凝的连续患者进行PlA基因型测定。28例患者植入搏动流Novacor（Novacor公司，加利福尼亚州奥克兰）和柏林心脏VAD（柏林心脏公司，德国柏林），13例患者植入轴流MicroMed DeBakey VAD（MicroMed技术公司，得克萨斯州休斯顿）。分析PlA基因型、抗凝方案与出血和血栓栓塞事件之间的关系。
A1A1和A1A2基因型患者在人口统计学特征、体重或感染发生率方面无差异。两组事件发生前的国际标准化比值（INR）、血小板活化试验以及阿司匹林和双嘧达莫剂量相似。A1A1基因型患者发生更多出血并发症（39%对0%，p = 0.021），而A1A2基因型患者有发生更多血栓栓塞事件的趋势（13%对30%，p = 0.33）。对于不同类型的VAD，植入轴流DeBakey VAD且为A1A1基因型的患者发生出血并发症显著更多（70%对0%，p = 0.033）。
对于长期使用VAD的患者，测定PlA多态性并随后调整抗凝方案可能会减少出血和血栓栓塞并发症。
