持续离心血流左心室辅助装置植入术后终末期心力衰竭患者获得性血小板疾病：一项前瞻性队列研究。
Acquired blood platelet disorder in patients with end-stage heart failure after implantation of a continuous centrifugal-flow left ventricular assist device: A prospective cohort study.
作者信息
Liesdek Omayra C D, Schutgens Roger E G, de Heer Linda M, Ramjankhan Faiz Z, Sebastian Silvie A E, Rohof Joline J, Suyker Willem J L, Urbanus Rolf T
机构信息
Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht University, the Netherlands.
Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, the Netherlands.
出版信息
Res Pract Thromb Haemost. 2023 Mar 6;7(2):100101. doi: 10.1016/j.rpth.2023.100101. eCollection 2023 Feb.
BACKGROUND
Continuous-flow left ventricular assist devices (CF-LVADs) are an established therapy for advanced heart failure. Thrombosis and hemorrhage are common complications after CF-LVAD implantation, which may be explained by device-induced platelet activation. Few data on the effect of CF-LVAD implantation on platelets are available to date.
OBJECTIVES
The aim of this study was to characterize the change in the platelet activation status after CF-LVAD.
METHODS
Platelet phenotype and reactivity were determined with flow cytometry in 32 adults with end-stage heart failure before and 4 to 6 weeks after CF-LVAD implantation. Sixteen adults with a biological aortic valve prosthesis (AVP) using the same antiplatelet regimen were included to discriminate between the effects of CF-LVAD and the antiplatelet regimen. Plasma markers for platelet activation were determined with enzyme-linked immunosorbent assay.
RESULTS
Median (IQR) plasma levels of soluble P-selectin increased from 115.6 (79.1-142.7) ng/mL to 144.5 (100.4-197.5) ng/mL after CF-LVAD implantation ( < .001). Median (IQR) β-thromboglobulin levels were 60.5 (37.8-81.5) ng/mL before implantation and remained high after LVAD implantation [60.0 (42.0-69.5) ng/mL]. The platelet P-selectin expression after stimulation with ADP (30 and 60 μM) or PAR1-activating peptide (12.5 and 25 μM) was reduced by 17% to 21%, and fibrinogen binding was reduced by 37% to 86%. Platelet responses to agonists were similar in patients with a CF-LVAD and patients with an AVP, except for fibrinogen binding in response to 12.5 μM PAR1-AP, which was lower in patients with a CF-LVAD ( < .001).
CONCLUSIONS
Combined, these data provide evidence for systemic platelet activation and an acquired platelet disorder after CF-LVAD implantation. This might contribute to the risk of both hemorrhage and thrombosis associated with CF-LVADs.
背景
连续流左心室辅助装置（CF-LVADs）是治疗晚期心力衰竭的一种既定疗法。血栓形成和出血是CF-LVAD植入术后常见的并发症，这可能是由装置诱导的血小板激活所解释的。迄今为止，关于CF-LVAD植入对血小板影响的数据很少。
目的
本研究的目的是描述CF-LVAD植入后血小板激活状态的变化。
方法
采用流式细胞术测定32例终末期心力衰竭成人患者在CF-LVAD植入前以及植入后4至6周时的血小板表型和反应性。纳入16例使用相同抗血小板方案的生物主动脉瓣置换术（AVP）成人患者，以区分CF-LVAD和抗血小板方案的影响。采用酶联免疫吸附测定法测定血小板激活的血浆标志物。
结果
CF-LVAD植入后，可溶性P-选择素的血浆水平中位数（IQR）从115.6（79.1-142.7）ng/mL升高至144.5（100.4-197.5）ng/mL（P<0.001）。植入前β-血小板球蛋白水平中位数（IQR）为60.5（37.8-81.5）ng/mL，LVAD植入后仍保持较高水平[60.0（42.0-69.5）ng/mL]。用ADP（30和60μM）或PAR1激活肽（12.5和25μM）刺激后，血小板P-选择素表达降低17%至21%，纤维蛋白原结合降低37%至86%。CF-LVAD患者和AVP患者对激动剂的血小板反应相似，但对12.5μM PAR1-AP的纤维蛋白原结合反应在CF-LVAD患者中较低（P<0.001）。
结论
综合来看，这些数据为CF-LVAD植入后全身血小板激活和获得性血小板疾病提供了证据。这可能导致与CF-LVAD相关的出血和血栓形成风险。
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