Document Detail


Discontinuation of antithrombotic therapy for a year or more in patients with continuous-flow left ventricular assist devices.
MedLine Citation:
PMID:  20639306     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The recommended anticoagulation regimen during continuous-flow axial left ventricular assist device (LVAD) support is aspirin and warfarin with a targeted international normalized ratio of 2.0-3.0. We report two patients in whom recurrent gastrointestinal bleeding during LVAD support necessitated discontinuation of this anti-thrombotic regimen for a year or more. Despite this, neither patients developed thrombotic complications during 29 patient-months of follow-up. An acquired von Willebrand factor (VWF) abnormality reflected by the absence or decreased abundance of the highest molecular weight multimers was demonstrated in both patients. The gold standard test for platelet function, light transmission platelet aggregometry was measured in one patient and was normal, indicative that the predominant abnormality in the coagulation profile of these patients is an acquired VWF syndrome. Clinical trials are required to address the question whether it is safe to discontinue anticoagulation in LVAD patients with acquired VWF abnormalities.
Authors:
Naveen L Pereira; Dong Chen; Sudhir S Kushwaha; Soon J Park
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, N.I.H., Extramural     Date:  2010-07-16
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  11     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-22     Completed Date:  2011-01-27     Revised Date:  2014-02-27    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  503-5     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiomyopathies / surgery*
Female
Fibrinolytic Agents / therapeutic use*
Gastrointestinal Hemorrhage / etiology*,  therapy
Heart-Assist Devices* / adverse effects
Humans
Male
Middle Aged
Recurrence
Thrombosis / etiology,  prevention & control*
Withholding Treatment
von Willebrand Diseases / etiology
Grant Support
ID/Acronym/Agency:
HL 84904/HL/NHLBI NIH HHS; UL1 RR024150/RR/NCRR NIH HHS; UL1RR24150/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents
Comments/Corrections
Comment In:
Interact Cardiovasc Thorac Surg. 2010 Oct;11(4):505; discussion 505-6   [PMID:  20858659 ]

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