Thorac Cardiovasc Surg 2013; 61 - P48
DOI: 10.1055/s-0032-1332688

Individual adapted platelet aggregation therapy in Heartware® patients – durable clopidogrel, acetylsalicylic acid or ticagrelor application

B Wiegmann 1, J Schmitto 1, M Avsar 1, S Rojas-Hernandez 1, JS Hanke 1, B Fleischer 1, M Dittrich 2, A Haverich 1, M Strüber 1, I Birschmann 3
  • 1Hannover Medical School, Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover, Germany
  • 2University of Würzburg, Department for Bioinformatics, Würzburg, Germany
  • 3University Clinic of the Ruhr-University Bochum, Institute for Laboratory and Transfusion Medicine, Bad Oeyenhausen, Germany

Objectives: Due to a limited supply of donor hearts, ventricular assist devices (VAD) are used as a bridge to transplantation and recovery. Like all artificial blood contacting devices, VAD therapy needs an exact adjustment to the anticoagulation regime, as bleedings and thrombosis are the most common adverse events. Generally, Heartware® patients receive coumarin and anti-platelet agents. The effectiveness of standard anti-platelet therapy (three times a week 75 mg clopidogrel) was analyzed in 49 Heartware® patients.

Methods: Evaluation of patients included demographic data, diagnosis, duration of hospital stay after VAD implantation, duration of VAD support and events of thrombosis and bleeding. Furthermore, functional testing of platelet aggregation inhibition in each patient was analyzed in platelet-rich plasma.

Results: Underlying diagnosis of patients (41 male, mean age 52) were DCM (n = 32), ICM (n = 15), acute myocardial infarction (n = 1) and acute myocarditis (n = 1). Duration of hospital stay was 36 days (range 15 – 229) and of VAD support 374 (range 30 – 1567). Whereas all patients started with 75 mg of Clopidogrel three times a week, medication was individually adapted dependent on platelet aggregation analysis and on bleeding events. 24 patients showed effective inhibition of platelet activation, whereas 9 patients have been effectively changed to acetylsalicylic acid three times a week and 14 patients are under observation. 2 patients showed normal platelet aggregation using clopidogrel or aspirin, so therapy was successfully (one ongoing) switched to 90 mg ticagrelor daily. Four of seven patients who had suffered from thromboembolic events before the start of our study showed insufficient platelet inhibition. Since the start of the study, there were no more severe bleeding events in patients with a change of medication.

Conclusion: These results show that it is necessary to check the effectiveness of anti-platelet therapy in VAD patients to avoid the most common complications: bleedings and thrombus formation.