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In-vivo Evidence for Contact Activation after Implantation of a Left Ventricular Assist Device in Patients with End-stage Heart Failure

1University Medical Center Utrecht, Cardiothoracic Surgery, Utrecht, the Netherlands, 2Van Creveld Clinic, University Medical Center Utrecht, Utrecht, the Netherlands, 3Leiden University Medical Center, Cardiothoracic Surgery, Leiden, the Netherlands, 4University Medical Center Utrecht, Central Diagnostic Laboratory, Utrecht, the Netherlands, 5University Medical Center Utrecht, Pathology, Utrecht, the Netherlands

Abstract Number: PB0264

Meeting: ISTH 2020 Congress

Theme: Coagulation and Natural Anticoagulants » Contact Pathway

Background: Left Ventricular Assist Devices (LVADs) are surgically implanted in patients with end-stage heart failure when pharmacological therapy is inadequate. Thrombus formation is a common cause of failure of these intracardiac surgical implants, despite adequate anticoagulation with vitamin K antagonists (VKA) and platelet inhibitors. It is likely that activation of the contact system by artificial surfaces of LVADs contributes to the prothrombotic effects of these devices. Clinical evidence to support this theory is lacking.

Aims: To evaluate contact system activation in patients before and after LVAD implantation.

Methods: Plasma levels of the contact system activation marker cleaved H-kininogen (cHK) were determined at 1 month, 6 months and 12 months after LVAD implantation in 40 patients. Measurements before LVAD implantation were used as reference.

Results: In 40 patients a LVAD was implantated between September 2011 and December 2017 as a bridge to heart transplantation. Two different centrifugal flow pumps (Heartmate III (N=13) and Heartware (N=8)) and a continuous-flow pump (Heartmate II N=19) were implantated in these patients. Plasma levels of cHK remained stable at 1 month after LVAD implantation (mean, 21.25% and interquartile range, 3.54-34.13%) compared with baseline levels (mean, 20.89% and interquartile range, 3.83-29.35%). At 6 months after LVAD implantation, plasma cHK levels (mean, 29.19% and interquartile range, 5.70-48.82%) were increased compared with baseline levels. At 12 months after LVAD implantation cHK levels (mean, 28.35% and interquartile range 4.25-44.92%) were similar to baseline again. Pump thrombosis occurred in 4 patients and was associated with a 1.8-4.4 fold increase in plasma cHK levels in comparison with baseline levels in each patient.

Conclusions: This study provides the first in vivo evidence of contact activation in patients after LVAD implantation.

To cite this abstract in AMA style:

Liesdek O, Urbanus R, de Heer L, Sebastian S, Vink A, Fischer K, Suyker W, Schutgens R. In-vivo Evidence for Contact Activation after Implantation of a Left Ventricular Assist Device in Patients with End-stage Heart Failure [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/in-vivo-evidence-for-contact-activation-after-implantation-of-a-left-ventricular-assist-device-in-patients-with-end-stage-heart-failure/. Accessed September 29, 2023.

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