Slaughter Mark S, Sobieski Michael A, Graham Joel D, Pappas Patroklos S, Tatooles Antone J, Koenig Steven C
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, Louisville, KY 40202, USA.
Int J Artif Organs. 2011 Jun;34(6):461-8. doi: 10.5301/IJAO.2011.8459.
Thromboembolic events have been observed in heart failure (HF) patients supported by long-term mechanical circulatory support (MCS) devices. It has been hypothesized that these adverse events may be the result of platelet activation associated with high rotational speeds common to axial flow pumps. In this study, markers of platelet activation were investigated in HF patients supported by a HeartMate II left ventricular assist device (LVAD).
The study group consisted of 34 HF patients supported by a HeartMate II axial flow LVAD implanted for destination therapy (DT). This patient population was 94% male (31 M, 3 F), supported by LVAD for 30 to 723 days (average 268 days), and with an anticoagulation regimen of Coumadin (0-8 mg daily dose) and aspirin (0-325 mg daily dose). Platelet adhesion markers (soluble P-selectin and solube CD40 ligand), platelet count (PC), hematocrit (Hct), and creatinine (Cr) were measured.
The soluble P-selectin marker was within normal platelet activity limits for all end points. The soluble CD40 ligand marker indicated platelet inactivity for all end points. Despite high shear stresses associated with a high-speed axial flow pump, the HeartMate II had no discernable effect on platelet activation. Current clinical doses of aspirin also appear to have little effect on platelet activation. Platelet count, hematocrit, and creatinine were normal in these patients over duration of support.
There were no discernable changes in platelet activation markers soluble P-selectin and soluble CD40 ligand in HF patients support by HeartMate II LVAD independently of length of support, anti-platelet, and anti-coagulation regimens.
在接受长期机械循环支持（MCS）装置治疗的心力衰竭（HF）患者中观察到了血栓栓塞事件。据推测，这些不良事件可能是与轴流泵常见的高转速相关的血小板激活的结果。在本研究中，对接受HeartMate II左心室辅助装置（LVAD）治疗的HF患者的血小板激活标志物进行了研究。
研究组由34例接受HeartMate II轴流LVAD植入以进行目标治疗（DT）的HF患者组成。该患者群体中男性占94%（31例男性，3例女性），接受LVAD支持30至723天（平均268天），抗凝方案为使用香豆素（每日剂量0 - 8毫克）和阿司匹林（每日剂量0 - 325毫克）。测量了血小板黏附标志物（可溶性P选择素和可溶性CD40配体）、血小板计数（PC）、血细胞比容（Hct）和肌酐（Cr）。
可溶性P选择素标志物在所有终点的正常血小板活性范围内。可溶性CD40配体标志物在所有终点均表明血小板无活性。尽管与高速轴流泵相关存在高剪切应力，但HeartMate II对血小板激活没有明显影响。目前临床剂量的阿司匹林似乎对血小板激活也几乎没有影响。在支持期间，这些患者的血小板计数、血细胞比容和肌酐均正常。
在接受HeartMate II LVAD治疗的HF患者中，可溶性P选择素和可溶性CD40配体这两种血小板激活标志物没有明显变化，且与支持时间长短、抗血小板和抗凝方案无关。
