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The endogenous thrombin potential in patients with left ventricular assist device or heart transplant
BACKGROUND: The Heartmate 3 (HM 3) is a left ventricular assist device featuring less shear stress, milder acquired von Willebrand syndrome, and fewer bleeding incidences than its predecessor the Heartmate II (HM II). The novel surface coating of the HM 3 suggests less contact activation of plasmati...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130672/ https://www.ncbi.nlm.nih.gov/pubmed/37122335 http://dx.doi.org/10.3389/fmed.2023.1155496 |
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author | Schlagenhauf, Axel Haidl, Harald Trummer, Georg Berchtold-Herz, Michael Pooth, Jan-Steffen Strini, Tanja Geisen, Ulrich Beyersdorf, Friedhelm Zieger, Barbara |
author_facet | Schlagenhauf, Axel Haidl, Harald Trummer, Georg Berchtold-Herz, Michael Pooth, Jan-Steffen Strini, Tanja Geisen, Ulrich Beyersdorf, Friedhelm Zieger, Barbara |
author_sort | Schlagenhauf, Axel |
collection | PubMed |
description | BACKGROUND: The Heartmate 3 (HM 3) is a left ventricular assist device featuring less shear stress, milder acquired von Willebrand syndrome, and fewer bleeding incidences than its predecessor the Heartmate II (HM II). The novel surface coating of the HM 3 suggests less contact activation of plasmatic coagulation. We hypothesized that patients with HM 3 exhibit fewer aberrations in their thrombin potential than patients with HM II. We compared these results with the thrombin potential of patients with heart transplantation (HTX). METHODS: Thrombin generation in plasma samples of patients with HM II (n = 16), HM 3 (n = 20), and HTX (n = 13) was analyzed 3 days after implantation/transplantation and after long-term support (3–24 months) with HM II (n = 16) or HM 3 (n = 12) using calibrated automated thrombography. Heparin in postoperative samples was antagonized with polybrene. RESULTS: Three days postoperatively HM II patients exhibited a lower endogenous thrombin potential (ETP) than HM 3 and HTX patients (HM II: 947 ± 291 nM*min; HM 3: 1231 ± 176 nM*min; HTX: 1376 ± 162 nM*min, p < 0.001) and a lower velocity index of thrombin generation (HM II: 18.74 ± 10.90 nM/min; HM 3: 32.41 ± 9.51 nM/min; HTX: 37.65 ± 9.41 nM/min, p < 0.01). Subtle differences in the thrombin generation profiles remained in HM II and HM 3 patients under long-term support (Velocity Index: HM II: 38.70 ± 28.46 nM/min; HM 3: 73.32 ± 32.83 nM/min, p < 0.05). Prothrombin fragments 1 + 2 were higher in HM II than in HM 3 patients (HM II: 377.7 ± 208.4 pM; HM 3: 202.1 ± 87.7 pM, p < 0.05) and correlated inversely with the ETP (r = −0.584, p < 0.05). CONCLUSION: We observed a more aberrant thrombin generation in HM II than in HM 3 despite comparable anticoagulation and routine parameters. A trend toward lower values was still observable in HM 3 compared to HTX patients. Calibrated automated thrombography may be a good tool to monitor the coagulation state of these patients and guide anticoagulation in the future. |
format | Online Article Text |
id | pubmed-10130672 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-101306722023-04-27 The endogenous thrombin potential in patients with left ventricular assist device or heart transplant Schlagenhauf, Axel Haidl, Harald Trummer, Georg Berchtold-Herz, Michael Pooth, Jan-Steffen Strini, Tanja Geisen, Ulrich Beyersdorf, Friedhelm Zieger, Barbara Front Med (Lausanne) Medicine BACKGROUND: The Heartmate 3 (HM 3) is a left ventricular assist device featuring less shear stress, milder acquired von Willebrand syndrome, and fewer bleeding incidences than its predecessor the Heartmate II (HM II). The novel surface coating of the HM 3 suggests less contact activation of plasmatic coagulation. We hypothesized that patients with HM 3 exhibit fewer aberrations in their thrombin potential than patients with HM II. We compared these results with the thrombin potential of patients with heart transplantation (HTX). METHODS: Thrombin generation in plasma samples of patients with HM II (n = 16), HM 3 (n = 20), and HTX (n = 13) was analyzed 3 days after implantation/transplantation and after long-term support (3–24 months) with HM II (n = 16) or HM 3 (n = 12) using calibrated automated thrombography. Heparin in postoperative samples was antagonized with polybrene. RESULTS: Three days postoperatively HM II patients exhibited a lower endogenous thrombin potential (ETP) than HM 3 and HTX patients (HM II: 947 ± 291 nM*min; HM 3: 1231 ± 176 nM*min; HTX: 1376 ± 162 nM*min, p < 0.001) and a lower velocity index of thrombin generation (HM II: 18.74 ± 10.90 nM/min; HM 3: 32.41 ± 9.51 nM/min; HTX: 37.65 ± 9.41 nM/min, p < 0.01). Subtle differences in the thrombin generation profiles remained in HM II and HM 3 patients under long-term support (Velocity Index: HM II: 38.70 ± 28.46 nM/min; HM 3: 73.32 ± 32.83 nM/min, p < 0.05). Prothrombin fragments 1 + 2 were higher in HM II than in HM 3 patients (HM II: 377.7 ± 208.4 pM; HM 3: 202.1 ± 87.7 pM, p < 0.05) and correlated inversely with the ETP (r = −0.584, p < 0.05). CONCLUSION: We observed a more aberrant thrombin generation in HM II than in HM 3 despite comparable anticoagulation and routine parameters. A trend toward lower values was still observable in HM 3 compared to HTX patients. Calibrated automated thrombography may be a good tool to monitor the coagulation state of these patients and guide anticoagulation in the future. Frontiers Media S.A. 2023-04-12 /pmc/articles/PMC10130672/ /pubmed/37122335 http://dx.doi.org/10.3389/fmed.2023.1155496 Text en Copyright © 2023 Schlagenhauf, Haidl, Trummer, Berchtold-Herz, Pooth, Strini, Geisen, Beyersdorf and Zieger. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Schlagenhauf, Axel Haidl, Harald Trummer, Georg Berchtold-Herz, Michael Pooth, Jan-Steffen Strini, Tanja Geisen, Ulrich Beyersdorf, Friedhelm Zieger, Barbara The endogenous thrombin potential in patients with left ventricular assist device or heart transplant |
title | The endogenous thrombin potential in patients with left ventricular assist device or heart transplant |
title_full | The endogenous thrombin potential in patients with left ventricular assist device or heart transplant |
title_fullStr | The endogenous thrombin potential in patients with left ventricular assist device or heart transplant |
title_full_unstemmed | The endogenous thrombin potential in patients with left ventricular assist device or heart transplant |
title_short | The endogenous thrombin potential in patients with left ventricular assist device or heart transplant |
title_sort | endogenous thrombin potential in patients with left ventricular assist device or heart transplant |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130672/ https://www.ncbi.nlm.nih.gov/pubmed/37122335 http://dx.doi.org/10.3389/fmed.2023.1155496 |
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