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Different Impact on the Coagulation System of Two Continuous Flow LVADs: Axial Versus Centrifugal Flow

https://doi.org/10.1016/j.healun.2013.01.425Get rights and content

Purpose

Antithrombotic therapy is essential in LVAD recipients and must be carefully titrated in each patient. Different devices might influence the coagulation system differently. An awareness of this may allow early planning of the most appropriate antithrombotic approach according to LVAD type. We studied the impact of two different continuous flow LVADs on the coagulation system: Jarvik 2000, an axial flow pump, versus HeartWare HVAD, a magnetically levitating centrifugal pump.

Methods and Materials

Results of platelet count, thromboelastometric and aggregometric tests were compared between 13 patients with Jarvik and 8 patients with HeartWare, all implanted in our center between 2008 and 2012.

Results

At 7, 14, 21 and 28 days HeartWare patients showed significantly higher levels of platelets, Intem-Extem MCF, TRAP and COL tests. After 2 months we observed a remarkable reduction of the markers of coagulation activation in HeartWare patients.

Conclusions

The two pumps have markedly different effects on hemostasis. The HeartWare causes hyperactivation of the coagulation system compared to the Jarvik. Accordingly, HeartWare patients usually need both anticoagulant and antiplatelet drugs, while Jarvik patients are usually managed only with anticoagulation.

TESTPOSTOP. DAYHVADJARVIKP
PLATELETS7241,4±113,9114,4±53,50,01
14457,7±109,1119,2±70,14< 0,0001
21385,2±75,8140,7±83,90,0002
28326,5±7,8168,9±81,30,03
60353±102,6166,1±77,90,002
135292±99180,1±900,17
INTEM MCF768,1±5,261,2±20,007
1473,8±7,364,4±3,20,0104
2177,5±3,258,2±6,40,0004
2876,1± 5,253,4±8,7< 0,0001
EXTEM MCF767,8±4,960±3,20,004
1471,9±5,563,4±60,02
2178±460,4±2,4< 0,0001
2875,5±6,954,2±4,20,0001
FIBTEM MCF732,5±4,528±2,40,03
1436,9±8,128±4,10,02
2141,5±13,130,6±6,80,09
2835,4±26,219,8±10,40,25
TRAP768,2±16,730,3±17,20,005
1486±20,753,2±28,60,05
2199,9±37,753±1,20,04
28108,1 ± 21,451,2±1,50,01
COL737±9,616,6±9,60,004
1435,8±1829,3±20,80,64
2134,8±3,917±8,50,01
2840,2±12,315±0,80,02

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