Vitamin K reduces bleeding in left ventricular assist device recipients

Richard J. Kaplon, A. Marc Gillinov, Nicholas G. Smedira, Kandice Kottke-Marchant, I-Wen Wang, Marlene Goormastic, Patrick M. McCarthy

Research output: Contribution to journalArticle

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Abstract

Background: Despite advances in left ventricular assist device (LVAD) design that permit support without anticoagulation, LVAD recipients often suffer profound bleeding complications. This bleeding diathesis may be attributable to pre-operative right-ventricular failure with concomitant hepatic dysfunction. The purpose of this study was to characterize coagulation abnormalities in LVAD recipients and determine the impact of pre- operative vitamin K administration on the incidence of postoperative bleeding. Methods: Hemostatic and liver function profiles were obtained in 66 recipients of the Heartmate LVAD; 39 of these patients received perioperative vitamin K. Results: During LVAD support, hepatic synthetic function improved as evidenced by increases in clotting factors II, V, VII, XI. There was ongoing fibrinolysis with elevation of fibrinopeptide A and D-dimers and diminution of fibrinogen; however, plasminogen levels did not decline suggesting that systemic disseminated intravascular coagulation (DIC) did not occur. Bleeding requiring re-exploration more than 48 hours postimplantation occurred in 9 of 66 patients (13.6%). Prior to implantation, patients that bled had decreased levels of factor II (52.2 ± 27.1% vs 69.7 ± 26.6%; p = 0.048) and prolonged prothrombin times (16.5 ± 2.4 seconds vs 13.8 ± 3.1 seconds; p = 0.005) compared to patients that did not bleed. Seven of 27 patients (25.9%) not treated with vitamin K bled, while only 2 of 39 (5.1%) Patients treated with vitamin K required re-exploration for bleeding (p = 0.026). Conclusions: We conclude that: (1) Liver synthetic function improves during LVAD support resulting in increased levels of circulating coagulation factors; (2) ongoing fibrinolysis occurs but likely only represents remodeling of fibrin on the LVAD surface; (3) perioperative vitamin K reduces nonsurgical bleeding in LVAD recipients.

Original languageEnglish (US)
Pages (from-to)346-350
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume18
Issue number4
DOIs
StatePublished - Apr 1999
Externally publishedYes

Fingerprint

Heart-Assist Devices
Vitamin K
Hemorrhage
Blood Coagulation Factors
Liver
Prothrombin
Fibrinolysis
Fibrinopeptide A
Equipment Design
Vitamin K 3
Disseminated Intravascular Coagulation
Plasminogen
Prothrombin Time
Disease Susceptibility
Hemostatics
Fibrin
Fibrinogen
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Kaplon, R. J., Gillinov, A. M., Smedira, N. G., Kottke-Marchant, K., Wang, I-W., Goormastic, M., & McCarthy, P. M. (1999). Vitamin K reduces bleeding in left ventricular assist device recipients. Journal of Heart and Lung Transplantation, 18(4), 346-350. https://doi.org/10.1016/S1053-2498(98)00066-7

Vitamin K reduces bleeding in left ventricular assist device recipients. / Kaplon, Richard J.; Gillinov, A. Marc; Smedira, Nicholas G.; Kottke-Marchant, Kandice; Wang, I-Wen; Goormastic, Marlene; McCarthy, Patrick M.

In: Journal of Heart and Lung Transplantation, Vol. 18, No. 4, 04.1999, p. 346-350.

Research output: Contribution to journalArticle

Kaplon, RJ, Gillinov, AM, Smedira, NG, Kottke-Marchant, K, Wang, I-W, Goormastic, M & McCarthy, PM 1999, 'Vitamin K reduces bleeding in left ventricular assist device recipients', Journal of Heart and Lung Transplantation, vol. 18, no. 4, pp. 346-350. https://doi.org/10.1016/S1053-2498(98)00066-7
Kaplon RJ, Gillinov AM, Smedira NG, Kottke-Marchant K, Wang I-W, Goormastic M et al. Vitamin K reduces bleeding in left ventricular assist device recipients. Journal of Heart and Lung Transplantation. 1999 Apr;18(4):346-350. https://doi.org/10.1016/S1053-2498(98)00066-7
Kaplon, Richard J. ; Gillinov, A. Marc ; Smedira, Nicholas G. ; Kottke-Marchant, Kandice ; Wang, I-Wen ; Goormastic, Marlene ; McCarthy, Patrick M. / Vitamin K reduces bleeding in left ventricular assist device recipients. In: Journal of Heart and Lung Transplantation. 1999 ; Vol. 18, No. 4. pp. 346-350.
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abstract = "Background: Despite advances in left ventricular assist device (LVAD) design that permit support without anticoagulation, LVAD recipients often suffer profound bleeding complications. This bleeding diathesis may be attributable to pre-operative right-ventricular failure with concomitant hepatic dysfunction. The purpose of this study was to characterize coagulation abnormalities in LVAD recipients and determine the impact of pre- operative vitamin K administration on the incidence of postoperative bleeding. Methods: Hemostatic and liver function profiles were obtained in 66 recipients of the Heartmate LVAD; 39 of these patients received perioperative vitamin K. Results: During LVAD support, hepatic synthetic function improved as evidenced by increases in clotting factors II, V, VII, XI. There was ongoing fibrinolysis with elevation of fibrinopeptide A and D-dimers and diminution of fibrinogen; however, plasminogen levels did not decline suggesting that systemic disseminated intravascular coagulation (DIC) did not occur. Bleeding requiring re-exploration more than 48 hours postimplantation occurred in 9 of 66 patients (13.6{\%}). Prior to implantation, patients that bled had decreased levels of factor II (52.2 ± 27.1{\%} vs 69.7 ± 26.6{\%}; p = 0.048) and prolonged prothrombin times (16.5 ± 2.4 seconds vs 13.8 ± 3.1 seconds; p = 0.005) compared to patients that did not bleed. Seven of 27 patients (25.9{\%}) not treated with vitamin K bled, while only 2 of 39 (5.1{\%}) Patients treated with vitamin K required re-exploration for bleeding (p = 0.026). Conclusions: We conclude that: (1) Liver synthetic function improves during LVAD support resulting in increased levels of circulating coagulation factors; (2) ongoing fibrinolysis occurs but likely only represents remodeling of fibrin on the LVAD surface; (3) perioperative vitamin K reduces nonsurgical bleeding in LVAD recipients.",
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T1 - Vitamin K reduces bleeding in left ventricular assist device recipients

AU - Kaplon, Richard J.

AU - Gillinov, A. Marc

AU - Smedira, Nicholas G.

AU - Kottke-Marchant, Kandice

AU - Wang, I-Wen

AU - Goormastic, Marlene

AU - McCarthy, Patrick M.

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N2 - Background: Despite advances in left ventricular assist device (LVAD) design that permit support without anticoagulation, LVAD recipients often suffer profound bleeding complications. This bleeding diathesis may be attributable to pre-operative right-ventricular failure with concomitant hepatic dysfunction. The purpose of this study was to characterize coagulation abnormalities in LVAD recipients and determine the impact of pre- operative vitamin K administration on the incidence of postoperative bleeding. Methods: Hemostatic and liver function profiles were obtained in 66 recipients of the Heartmate LVAD; 39 of these patients received perioperative vitamin K. Results: During LVAD support, hepatic synthetic function improved as evidenced by increases in clotting factors II, V, VII, XI. There was ongoing fibrinolysis with elevation of fibrinopeptide A and D-dimers and diminution of fibrinogen; however, plasminogen levels did not decline suggesting that systemic disseminated intravascular coagulation (DIC) did not occur. Bleeding requiring re-exploration more than 48 hours postimplantation occurred in 9 of 66 patients (13.6%). Prior to implantation, patients that bled had decreased levels of factor II (52.2 ± 27.1% vs 69.7 ± 26.6%; p = 0.048) and prolonged prothrombin times (16.5 ± 2.4 seconds vs 13.8 ± 3.1 seconds; p = 0.005) compared to patients that did not bleed. Seven of 27 patients (25.9%) not treated with vitamin K bled, while only 2 of 39 (5.1%) Patients treated with vitamin K required re-exploration for bleeding (p = 0.026). Conclusions: We conclude that: (1) Liver synthetic function improves during LVAD support resulting in increased levels of circulating coagulation factors; (2) ongoing fibrinolysis occurs but likely only represents remodeling of fibrin on the LVAD surface; (3) perioperative vitamin K reduces nonsurgical bleeding in LVAD recipients.

AB - Background: Despite advances in left ventricular assist device (LVAD) design that permit support without anticoagulation, LVAD recipients often suffer profound bleeding complications. This bleeding diathesis may be attributable to pre-operative right-ventricular failure with concomitant hepatic dysfunction. The purpose of this study was to characterize coagulation abnormalities in LVAD recipients and determine the impact of pre- operative vitamin K administration on the incidence of postoperative bleeding. Methods: Hemostatic and liver function profiles were obtained in 66 recipients of the Heartmate LVAD; 39 of these patients received perioperative vitamin K. Results: During LVAD support, hepatic synthetic function improved as evidenced by increases in clotting factors II, V, VII, XI. There was ongoing fibrinolysis with elevation of fibrinopeptide A and D-dimers and diminution of fibrinogen; however, plasminogen levels did not decline suggesting that systemic disseminated intravascular coagulation (DIC) did not occur. Bleeding requiring re-exploration more than 48 hours postimplantation occurred in 9 of 66 patients (13.6%). Prior to implantation, patients that bled had decreased levels of factor II (52.2 ± 27.1% vs 69.7 ± 26.6%; p = 0.048) and prolonged prothrombin times (16.5 ± 2.4 seconds vs 13.8 ± 3.1 seconds; p = 0.005) compared to patients that did not bleed. Seven of 27 patients (25.9%) not treated with vitamin K bled, while only 2 of 39 (5.1%) Patients treated with vitamin K required re-exploration for bleeding (p = 0.026). Conclusions: We conclude that: (1) Liver synthetic function improves during LVAD support resulting in increased levels of circulating coagulation factors; (2) ongoing fibrinolysis occurs but likely only represents remodeling of fibrin on the LVAD surface; (3) perioperative vitamin K reduces nonsurgical bleeding in LVAD recipients.

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