Key result
LVAD patients on warfarin and aspirin had greater inhibition of collagen-induced platelet aggregation than controls (31.8% vs 7.9%; P=.004), yielding a profile similar to warfarin alone.
Why the study?
Does standard anticoagulant therapy (warfarin and aspirin) adequately suppress coagulation and platelet activation in patients with LVADs?
Observational (n=17)
Does standard anticoagulant therapy (warfarin and aspirin) adequately suppress coagulation and platelet activation in patients with LVADs?
Absolute Event Rate: 31.8% vs 7.9%
p-value: p=.004
Standard pharmacotherapy with warfarin and aspirin effectively suppresses LVAD-induced coagulation and platelet activation, yielding a profile similar to patients on warfarin alone.
Questions additive value of aspirin to warfarin in LVADs; hypothesis-generating for de-escalation trials.
Left ventricular assist devices (LVADs) are mechanical pumps that enhance cardiac function in patients with heart failure. In all, 7 patients with an LVADs (1.8 international normalized ratio warfarin, 81 mg aspirin) were evaluated monthly for 3 months for platelet and coagulation activation (controls: 5 healthy adults and 5 patients having warfarin). Platelet works revealed greater inhibition of collagen (31.8% vs 7.9%; P = .004), arachidonate- (30.9% vs 8.2%; P = .001), and adenosine diphosphate- (10.9% vs 6.1%; P = .004)-induced platelet aggregation for LVADs. Thrombelastography (recalcified whole blood) showed inhibition of clot initiation time (R; 8.81 vs 6.02 min; P = .001) and stronger clot formation (maximum amplitude; 69.1 vs 64.9 mm; P = .016). Platelet function determined by plateletMapping and flow cytometry was within the normal range. The LVADs had increased ratio of von Willebrand Factor (vWF) antigen and vWF propeptide, indicating increased degradation of vWF (2.04 vs 1.44; P = .144). Coagulation and platelet activation caused by LVAD is suppressed by pharmacotherapy, yielding a profile similar to that of patients on warfarin alone.
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Ashbrook et al. (2012) conducted an observational in Heart failure (n=17). Left ventricular assist device (LVAD) with anticoagulant therapy vs. Healthy adults and patients on warfarin alone was evaluated on Inhibition of collagen-induced platelet aggregation (p=.004). LVAD patients on warfarin and aspirin had greater inhibition of collagen-induced platelet aggregation than controls (31.8% vs 7.9%; P=.004), yielding a profile similar to warfarin alone.
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