Pathophysiologic role of contact activation in bleeding followed by thromboembolic complications after implantation of a ventricular assist device

G. Himmelreich, H. Ullmann, H. Riess, R. Rosch, Matthias Loebe, A. Schiessler, R. Hetzer

Research output: Contribution to journalArticle

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Abstract

The time period after implantation of a ventricular assist device in patients with end-stage heart disease is complicated by hemorrhage in the early postoperative period and by thromboembolism in the later course. To investigate the pathophysiologic role of contact activation in 12 bridging patients (10 patients with a paracorporeal Berlin Heart [Berlin Heart GmbH, Berlin, Germany], 2 patients with an intracorporeal Novacor system [Novacor N100; Baxter, Oakland, CA], hemostatic parameters were determined until heart transplantation or at least up to the 51st postoperative day. The following were observed: 1) In the early postoperative period, until day 15, levels of contact factors XI, XII, and prekallikrein were below normal, whereas levels of plasmin-a2-antiplasmin (PAP) complexes were elevated. Thrombin-antithrombin III (TAT) complexes, as well as platelet factor 4 and β-thromboglobulin, significantly increased immediately after surgery. 2) In the later postoperative period, starting with the third postoperative week, an increase of factors XI, XII, and prekallikrein was observed. PAP and TAT complexes, as well as platelet factor 4 and β thromboglobulin, remained elevated. It is concluded that, in the early postoperative period, hemostasis is influenced mainly by an activation of the intrinsic contact system dependent fibrinolytic system with consumption of contact factors and increased levels of PAP complexes, whereas later system dependent fibrinolysis becomes less important, leading to a shift of the balance toward coagulation, with sustained prothrombin and platelet activation. This is in accord with the observed clinical complications (e.g., early postoperative bleeding, and thromboembolic events later on).

Original languageEnglish (US)
JournalASAIO Journal
Volume41
Issue number3
StatePublished - 1995
Externally publishedYes

Fingerprint

Heart-Assist Devices
Postoperative Period
Ion implantation
Antifibrinolytic Agents
Fibrinolysin
Berlin
Platelets
Chemical activation
Factor XI
Prekallikrein
Hemorrhage
Factor XII
Platelet Factor 4
Thromboembolism
Platelet Activation
Prothrombin
Fibrinolysis
Hemostatics
Heart Transplantation
Coagulation

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering

Cite this

Pathophysiologic role of contact activation in bleeding followed by thromboembolic complications after implantation of a ventricular assist device. / Himmelreich, G.; Ullmann, H.; Riess, H.; Rosch, R.; Loebe, Matthias; Schiessler, A.; Hetzer, R.

In: ASAIO Journal, Vol. 41, No. 3, 1995.

Research output: Contribution to journalArticle

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