This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wilhelm, C. R. Articles by Wagner, W. R. Search for Related Content PubMed PubMed Citation Articles by Wilhelm, C. R. Articles by Wagner, W. R. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Stroke Related Collections CV surgery: transplantation, ventricular assistance, cardiomyopathy Embolic stroke Doppler ultrasound, Transcranial Doppler etc. Coagulation and fibronolysis Platelets

(Stroke. 1999;30:2554.)
© 1999 American Heart Association, Inc.

Original Contributions

Measurement of Hemostatic Indexes in Conjunction With Transcranial Doppler Sonography in Patients With Ventricular Assist Devices

Carl R. Wilhelm, BS; Julianne Ristich, BS; Laurie E. Knepper, MD; Richard Holubkov, PhD; Stephen R. Wisniewski, PhD; Robert L. Kormos, MD William R. Wagner, PhD

From the Department of Surgery (Cardiothoracic) and McGowan Center for Artificial Organ Development (C.R.W., J.R., R.L.K., W.R.W.), the Department of Bioengineering (C.R.W., W.R.W.), the Department of Neurology (L.E.K.), and the Department of Epidemiology (R.H., S.R.W.), University of Pittsburgh, Pittsburgh, Pa.

Correspondence to William R. Wagner, PhD, Department of Surgery, 328 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261. E-mail wagnerwr{at}msx.upmc.edu

Background and Purpose—Clinical thromboembolism (TE) remains an impediment to the chronic application of ventricular assist devices (VADs). Microembolic signals (MES) have been detected by transcranial Doppler ultrasound (TCD) in patients with VADs, although their origin and relation to TE remain undefined. We have investigated the hypothesis that hemostatic alterations are related to MES and that MES are associated with TE in a group of 27 VAD patients.

Methods—Indexes of coagulation, fibrinolysis, and cellular activation and aggregation were measured before and during the VAD implantation period in conjunction with TCD. Groups were defined on the basis of presence of MES, degree of MES showering, and incidence of TE.

Results—MES were observed in 67 (58%) of 115 of individual postoperative TCD measurements and in 21 (78%) of 27 patients. Of patients with TE, 10 (83%) of 12 had detectable MES compared with 11 (73%) of 15 patients without TE (P=0.66). MES were significantly associated with elevated thrombin generation during the implantation period, as reflected by plasma prothrombin fragment F1.2. Elevations in indexes of coagulation, platelet activation, and fibrinolysis relative to normal control subjects were found for patients with VADs with and without detected MES.

Conclusions—Although no significant relation between MES and TE in VAD patients was found, the data support the hypothesis that MES are related to increased hemostatic activity in this patient group despite aggressive anticoagulant therapy.

Key Words: heart assist • flow cytometry • hemostasis • ultrasonography, Doppler, transcranial

This article has been cited by other articles:

				R. John, F. Kamdar, K. Liao, M. Colvin-Adams, L. Miller, L. Joyce, and A. Boyle Low thromboembolic risk for patients with the Heartmate II left ventricular assist device. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1318 - 1323. [Abstract] [Full Text] [PDF]

				R. Dittrich and E. B. Ringelstein Occurrence and Clinical Impact of Microembolic Signals During or After Cardiosurgical Procedures Stroke, February 1, 2008; 39(2): 503 - 511. [Abstract] [Full Text] [PDF]

				A. Joshi, L. S. Magder, Z. Kon, S. Kallam, M. Kwon, R. Sangrampurkar, R. Pierson, and R. Poston Association between prothrombin activation fragment (F1.2), cerebral ischemia (S-100{beta}) and international normalized ratio (INR) in patients with ventricular assisted devices Interactive CardioVascular and Thoracic Surgery, June 1, 2007; 6(3): 323 - 327. [Abstract] [Full Text] [PDF]

				D. D. Doblar Intraoperative Transcranial Ultrasonic Monitoring for Cardiac and Vascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2004; 8(2): 127 - 145. [Abstract] [PDF]

				T. A. Snyder, M. J. Watach, K. N. Litwak, and W. R. Wagner Platelet activation, aggregation, and life span in calves implanted with axial flow ventricular assist devices Ann. Thorac. Surg., June 1, 2002; 73(6): 1933 - 1938. [Abstract] [Full Text] [PDF]