What is the clinical evidence from this study?

Study design: Case Report. Population: Left Ventricular Assist Device (LVAD) support with recurrent thromboembolic events (n=1). Intervention: Heart transplantation vs. LVAD support. Primary outcome: Platelet Activity State (PAS).

What does this research mean for the field?

Shear-mediated platelet activation correlates with thromboembolic complications during LVAD support and is completely reversed following heart transplantation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 27, 2018ASAIO JournalOpen Access

Shear-Mediated Platelet Activation Enhances Thrombotic Complications in Patients With LVADs and Is Reversed After Heart Transplantation

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Key result

Heart transplantation normalizes elevated platelet activity state to ~1% following refractory LVAD thrombosis.

Why the study?

Shear-mediated platelet activation is a key factor associated with thrombotic complications in patients supported by LVADs, but its dynamics and reversibility were not fully understood.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

1 patient supported by a Left Ventricular Assist Device (LVAD) who developed recurrent thromboembolic events over the course of support.

Exposure

Time-series monitoring of Platelet Activity State (PAS) during LVAD support, pump exchange, and after heart transplantation

Outcome

Shear-mediated platelet activation (SMPA) quantified via the Platelet Activity State (PAS) assaysurrogate

Shear-mediated platelet activation quantified by the PAS assay correlates with thrombotic complications in LVAD support and resolves after heart transplantation.

Implication

May support transplant evaluation in select LVAD patients with recurrent events; hypothesis-generating and needs validation in prospective studies.

Abstract

We present a time-series analysis of shear-mediated platelet activation (SMPA) in a patient supported by a Left Ventricular Assist Device (LVAD) who developed recurrent thromboembolic events over the course of support. The patient showed marked alterations of SMPA as quantified via the Platelet Activity State (PAS) assay. At the time of a first pump thrombosis, PAS was equal to 16.2 ± 2.1%, indicating a significant level of SMPA. A moderate decrease of PAS was observed 30 days after pump exchange (PAS = 9.5 ± 1.0%). A sudden PAS increase was recorded after 60 days (PAS = 60.5 ± 4.3%), and an ischemic stroke with hemorrhagic transformation was subsequently diagnosed at 120 days after pump exchange (PAS = 86.9 ± 7.5%); high PAS values did not recover over time likely because of sustained platelet activation from the inflammatory milieu caused by a driveline infection occurred at 240 days of support (PAS = 84.4 ± 7.3%). PAS values were completely reversed after heart transplantation (PAS = 0.6 ± 0.1%), demonstrating resolution of SMPA. This study provides further insight into our understanding of the pathogenesis of LVAD thrombosis, addressing SMPA as a relevant key factor associated with thrombotic complications. With the PAS assay, we have identified a reliable biomarker to promote tailored pharmacological therapy for the prevention of thromboembolic events in patients with LVADs.

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Cite This Study

Consolo et al. (2018) conducted a case report in Left Ventricular Assist Device (LVAD) support with recurrent thromboembolic events (n=1). Heart transplantation vs. LVAD support was evaluated on Platelet Activity State (PAS). Heart transplantation completely reversed high Platelet Activity State (PAS) values (from up to 86.9% during LVAD support to 0.6%) in a patient with recurrent thromboembolic events.

synapsesocial.com/papers/6ab72164344ad2f4d8e41245 https://doi.org/10.1097/mat.0000000000000842