Protein C Pathway, Inflammation, and Pump Thrombosis in Patients With Left Ventricular Assist Devices

Figure 1.. C-reactive protein (CRP) levels in LVAD implanted patients before and after LVAD associated thrombotic events. Elevated CRP levels in this patient population before the thrombotic event (mean 32.7 mg/L vs 2.5 mg/L in normal healthy individuals [NHP], p < 0.0001) did not alter following a thrombotic event. The mean CRP level in LVAD patients before and after an LVAD associated bleeding event was approximately 9 mg/L.

Figure 2.. Total protein S levels in LVAD implanted patients before and after LVAD associated thrombotic events. Total protein S levels were lower than normal in this patient population before the thrombotic event (mean 48.5% vs 70.4% in normal healthy individuals [NHP], p < 0.05) and slightly decreased following a thrombotic event to 40.3%.

Figure 3.. Free protein S levels in LVAD implanted patients before and after LVAD associated thrombotic events. Free protein S levels were lower than normal in this patient population before the thrombotic event (mean 50.3% vs 82.5% in normal healthy individuals [NHP], p < 0.05) and markedly decreased following a thrombotic event to 37.7% (p = 0.033).

Figure 4.. Protein C levels in LVAD implanted patients before and after LVAD associated thrombotic events. Protein C levels were lower than normal in this patient population before the thrombotic event (mean 57.5% vs 99.6% in normal healthy individuals [NHP], p < 0.05) and slightly decreased following a thrombotic event to 50.5%.

Figure 5.. Soluble EPCR levels in in LVAD implanted patients before and after LVAD associated thrombotic events. Soluble EPCR levels were lower than normal in this patient population before the thrombotic event (mean 513 ng/mL vs 831 ng/mL in normal healthy individuals [NHP], p < 0.05) and slightly decreased following a thrombotic event to 437 ng/mL.

Figure 6.. Soluble thrombomodulin levels in LVAD implanted patients before and after LVAD associated thrombotic events. Soluble thrombomodulin levels were at normal levels in this patient population before the thrombotic event (mean 3.5 ng/mL vs 3.3 ng/mL in normal healthy individuals [NHP]) and did not alter following a thrombotic event.