左心室辅助装置(LVAD)上的患者由于人工泵表面与血液成分的永久接触而容易出现过多的止血障碍。我们旨在研究长期连续流动LVAD治疗患者的纤维蛋白凝块通透性是否改变,以及凝块通透性是否与临床特征和不良事件相关。我们调查了85名终末期心力衰竭患者(90.6%为男性,年龄48.6-63.8岁)根据当前临床适应症安排连续流动长期LVAD支持。定期对患者进行评估:LVAD植入前(T1),LVAD植入后3-6个月(T2),(T3)后6-12个月,然后每6个月。我们测试了前三个血液样本(T1-T3)和最后一个可用的血液样本(T4),但不超过LVAD植入后5年。我们评估了止血参数(活化部分凝血活酶时间(APTT)凝血酶原时间,活化部分凝血活酶时间,纤维蛋白原,D-二聚体,抗凝血酶,凝血酶时间,因子VIII,和vonWillebrand因子,阿司匹林诱导的血小板抑制,腺苷二磷酸试验)在研究期间的变化。使用压力系统评价纤维蛋白凝块渗透性并计算渗透性系数(Ks)。我们观察到在T1、T2、T3和T4时间段之间纤维蛋白凝块通透性(Ks)降低;对于每个比较,P<0.01。纤维蛋白凝块通透性与纤维蛋白原浓度呈负相关:r=-0.51,P<0.001,因子VIII活性r=-0.42,P<0.001。Ks与年龄没有关联,左心室射血分数(LVEF)和药物治疗P>0.001,但是阿司匹林患者的累积测量显示该组中Ks缩短P=0.0123。36.5%的患者发生主要不良心脑血管事件(MACCE),出血事件占25.9%,净不良临床事件(NACE)占62.4%;31.7%的患者死亡,17.6%接受移植。移植被认为是终点。在MACCE患者之间观察到Ks的差异,出血,NACE,和无不良事件的患者。Ks仅在无不良事件的患者中显示出恒定的正常化趋势(P<0.01)。晚期心力衰竭患者的凝块结构紊乱。在这组患者中,Ks值正常化的趋势与较少的血栓栓塞和出血并发症有关。
Patients on left ventricular assist devices (LVAD) are prone to excessive hemostasis disturbances due to permanent contact of artificial pump surfaces with blood components. We aimed to investigate if fibrin clot permeability is altered in patients on long-term continuous-flow LVAD therapy and if the clot permeability is associated with clinical characteristics and adverse events. We investigated 85 end-stage heart failure patients (90.6% men, age 48.6-63.8 years) scheduled for continuous flow long-term LVAD support according to current clinical indications. The patients were assessed periodically: prior to LVAD implantation (T1), 3-6 months (T2) after LVAD implantation, 6-12 months after (T3) and then every 6 months. We tested the first three blood samples (T1-T3) and the last available blood sample (T4), but no longer than 5 years after LVAD implantation. We assessed hemostasis parameters (Activated Partial Thromboplastin Time (APTT) Prothrombin Time, Activated Partial Thromboplastin Time, Fibrinogen, D-dimer, Antithrombin, Thrombin Time, Factor VIII, and von Willebrand Factor, aspirin-induced platelet inhibition, adenosine-diphosphate test) changes during the study period. Fibrin Clot Permeability was evaluated using a pressure system and Permeability Coefficient (Ks) was calculated. We observed a decrease in fibrin clot permeability (Ks) between T1, T2, T3 and T4 time periods; P < 0.01 for each comparison. Fibrin clot permeability was negatively correlated with fibrinogen concentration: r = - 0.51, P < 0.001, factor VIII activity r = - 0.42, P < 0.001. There was no association of Ks with age, Left Ventricular Ejection Fraction (LVEF) and medications P > 0.001, however cumulative measurements in patients on aspirin showed shortening of Ks in this group P = 0.0123. Major adverse cardiac and cerebrovascular events (MACCE) occurred in 36.5% patients, bleeding events in 25.9%, Net Adverse Clinical Events (NACE) in 62.4%; 31.7% patients died, and 17.6% underwent transplantation. The transplantation was considered as the endpoint. Discrepancies in Ks were observed between patients with MACCE, bleeding, and NACE, and patients without adverse events. Ks showed a constant trend towards normalization (P < 0.01) only in patients without adverse events. Patients with advanced heart failure have disturbed clot structure. A trend towards normalization of the Ks values is associated with fewer thromboembolic and bleeding complications in this group of patients.