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• W2091708964 abstract "Ventricular assist devices (VADs) are associated with thromboembolic events. Aspirin hyporesponsiveness has been associated with an increased risk of future vascular atherothrombotic events, such as acute coronary syndromes and cerebrovascular accidents, but whether this disorder can predict future clinical thromboembolic events in patients with VADs remains unclear. In this article, the prevalence and clinical relevance of aspirin hyporesponsiveness before and after VAD implantation and the role of markers of coagulation and fibrinolysis were assessed. Background Long-term success in ventricular assist device (VAD) recipients is limited by thromboembolic events, the prediction of which remains elusive. We evaluated the predictive value of aspirin hyporesponsiveness and markers of coagulation and fibrinolysis. Methods We prospectively enrolled patients scheduled to undergo VAD implantation between June 2004 and March 2006. Once before surgery, daily during hospitalization, and weekly after discharge we assessed platelet function, measured prothrombin activation fragment 1.2 (F1.2) and plasminogen activator inhibitor-1 (PAI-1) concentrations, and evaluated aspirin hyporesponsiveness by whole-blood aggregometry and thromboelastography. All patients received 325 mg oral aspirin daily from at least 7 days before VAD implantation. Follow-up continued until heart transplantation, death or closure of the database. Results We included 26 patients (median follow-up 315 days, range 9–833 days). In eight (31%) patients, 14 thromboembolic events occurred at a median of 42 (interquartile range 26–131) days. Only six (43%) events based on whole-blood aggregometry and one (7%) based on thromboelastography coincided with aspirin hyporesponsiveness. Within-patient variability was high for both tests (59% and 567%, respectively). Compared with levels before surgery, PAI-1 concentrations were raised for up to 45 days (P <0.0001) and those of F1.2 for up to 3 days (P = 0.0001) after VAD implantation. PAI-1 and F1.2 levels did not rise significantly further before thromboembolic events. Conclusions Aspirin hyporesponsiveness was not associated with raised risk of future clinical thromboembolic events after VAD implantation. Impaired fibrinolysis, demonstrated by raised PAI-1 concentrations, might, however, indicate a predisposition to such events early after surgery." @default.
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• W2091708964 date "2009-02-01" @default.
• W2091708964 modified "2023-10-16" @default.
• W2091708964 title "Prospective, observational study of antiplatelet and coagulation biomarkers as predictors of thromboembolic events after implantation of ventricular assist devices" @default.
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• W2091708964 doi "https://doi.org/10.1038/ncpcardio1441" @default.
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