Pediatric Acquired von Willebrand Disease With Berlin Heart Excor Ventricular Assist Device Support

Nathan Gossai, Nicholas M. Brown, Rebecca K Ameduri, Nicole D Zantek, James St Louis, Marie E Steiner

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

BACKGROUND: The balance of hemostasis and anticoagulation is a concern for patients dependent upon ventricular assist devices (VADs). Bleeding is a common complication with both short- and long-term use of these devices. A better understanding of the risk factors and etiologies of bleeding associated with these devices is needed and could improve the overall results. We sought to determine the relationship of mechanical circulatory assist device use with acquired von Willebrand disease (avWD) in children.

METHODS: Data were analyzed retrospectively via review of the medical record of 19 consecutive patients who were supported with the Berlin EXCOR VAD for greater than 24 hours. Laboratory testing for avWD was performed at the discretion of the clinical team, often in association with clinical bleeding.

RESULTS: Of 19 pediatric patients, 10 (52.6%) had laboratory testing consistent with avWD. Median time to detection of avWD was 35 days postimplantation of device (range 0-310 days). Both minor mucosal bleeding and bleeding requiring intervention were highly prevalent in patients in whom avWD was identified (10/10 [100%] and 7/10 [70%]). The mean age of all patients was 3.3 years, but patients found to have avWD tended to be older (mean 5.3 years) and supported with larger volume VADs.

CONCLUSIONS: This experience demonstrates a high prevalence of avWD following EXCOR implantation. Bleeding, older age, and larger VAD size may be associated with avWD. These results should stimulate critical evaluation of individualized anticoagulation regimens in pediatric VAD patients.

Original languageEnglish (US)
Pages (from-to)614-618
Number of pages5
JournalWorld journal for pediatric & congenital heart surgery
Volume7
Issue number5
DOIs
StatePublished - Sep 1 2016

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von Willebrand Diseases
Heart-Assist Devices
Berlin
Pediatrics
Hemorrhage
Equipment and Supplies
Hemostasis
Medical Records

Keywords

  • bleeding
  • circulatory support devices
  • heart failure
  • heart transplantation

Cite this

@article{f595f7989fbd41dda77dc5f2808acad1,
title = "Pediatric Acquired von Willebrand Disease With Berlin Heart Excor Ventricular Assist Device Support",
abstract = "BACKGROUND: The balance of hemostasis and anticoagulation is a concern for patients dependent upon ventricular assist devices (VADs). Bleeding is a common complication with both short- and long-term use of these devices. A better understanding of the risk factors and etiologies of bleeding associated with these devices is needed and could improve the overall results. We sought to determine the relationship of mechanical circulatory assist device use with acquired von Willebrand disease (avWD) in children.METHODS: Data were analyzed retrospectively via review of the medical record of 19 consecutive patients who were supported with the Berlin EXCOR VAD for greater than 24 hours. Laboratory testing for avWD was performed at the discretion of the clinical team, often in association with clinical bleeding.RESULTS: Of 19 pediatric patients, 10 (52.6{\%}) had laboratory testing consistent with avWD. Median time to detection of avWD was 35 days postimplantation of device (range 0-310 days). Both minor mucosal bleeding and bleeding requiring intervention were highly prevalent in patients in whom avWD was identified (10/10 [100{\%}] and 7/10 [70{\%}]). The mean age of all patients was 3.3 years, but patients found to have avWD tended to be older (mean 5.3 years) and supported with larger volume VADs.CONCLUSIONS: This experience demonstrates a high prevalence of avWD following EXCOR implantation. Bleeding, older age, and larger VAD size may be associated with avWD. These results should stimulate critical evaluation of individualized anticoagulation regimens in pediatric VAD patients.",
keywords = "bleeding, circulatory support devices, heart failure, heart transplantation",
author = "Nathan Gossai and Brown, {Nicholas M.} and Ameduri, {Rebecca K} and Zantek, {Nicole D} and Louis, {James St} and Steiner, {Marie E}",
year = "2016",
month = "9",
day = "1",
doi = "10.1177/2150135116651836",
language = "English (US)",
volume = "7",
pages = "614--618",
journal = "World Journal for Pediatric and Congenital Hearth Surgery",
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}

TY - JOUR

T1 - Pediatric Acquired von Willebrand Disease With Berlin Heart Excor Ventricular Assist Device Support

AU - Gossai, Nathan

AU - Brown, Nicholas M.

AU - Ameduri, Rebecca K

AU - Zantek, Nicole D

AU - Louis, James St

AU - Steiner, Marie E

PY - 2016/9/1

Y1 - 2016/9/1

N2 - BACKGROUND: The balance of hemostasis and anticoagulation is a concern for patients dependent upon ventricular assist devices (VADs). Bleeding is a common complication with both short- and long-term use of these devices. A better understanding of the risk factors and etiologies of bleeding associated with these devices is needed and could improve the overall results. We sought to determine the relationship of mechanical circulatory assist device use with acquired von Willebrand disease (avWD) in children.METHODS: Data were analyzed retrospectively via review of the medical record of 19 consecutive patients who were supported with the Berlin EXCOR VAD for greater than 24 hours. Laboratory testing for avWD was performed at the discretion of the clinical team, often in association with clinical bleeding.RESULTS: Of 19 pediatric patients, 10 (52.6%) had laboratory testing consistent with avWD. Median time to detection of avWD was 35 days postimplantation of device (range 0-310 days). Both minor mucosal bleeding and bleeding requiring intervention were highly prevalent in patients in whom avWD was identified (10/10 [100%] and 7/10 [70%]). The mean age of all patients was 3.3 years, but patients found to have avWD tended to be older (mean 5.3 years) and supported with larger volume VADs.CONCLUSIONS: This experience demonstrates a high prevalence of avWD following EXCOR implantation. Bleeding, older age, and larger VAD size may be associated with avWD. These results should stimulate critical evaluation of individualized anticoagulation regimens in pediatric VAD patients.

AB - BACKGROUND: The balance of hemostasis and anticoagulation is a concern for patients dependent upon ventricular assist devices (VADs). Bleeding is a common complication with both short- and long-term use of these devices. A better understanding of the risk factors and etiologies of bleeding associated with these devices is needed and could improve the overall results. We sought to determine the relationship of mechanical circulatory assist device use with acquired von Willebrand disease (avWD) in children.METHODS: Data were analyzed retrospectively via review of the medical record of 19 consecutive patients who were supported with the Berlin EXCOR VAD for greater than 24 hours. Laboratory testing for avWD was performed at the discretion of the clinical team, often in association with clinical bleeding.RESULTS: Of 19 pediatric patients, 10 (52.6%) had laboratory testing consistent with avWD. Median time to detection of avWD was 35 days postimplantation of device (range 0-310 days). Both minor mucosal bleeding and bleeding requiring intervention were highly prevalent in patients in whom avWD was identified (10/10 [100%] and 7/10 [70%]). The mean age of all patients was 3.3 years, but patients found to have avWD tended to be older (mean 5.3 years) and supported with larger volume VADs.CONCLUSIONS: This experience demonstrates a high prevalence of avWD following EXCOR implantation. Bleeding, older age, and larger VAD size may be associated with avWD. These results should stimulate critical evaluation of individualized anticoagulation regimens in pediatric VAD patients.

KW - bleeding

KW - circulatory support devices

KW - heart failure

KW - heart transplantation

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DO - 10.1177/2150135116651836

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JO - World Journal for Pediatric and Congenital Hearth Surgery

JF - World Journal for Pediatric and Congenital Hearth Surgery

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