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J Thorac Cardiovasc Surg 2004;128:197-202
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Platelet activation and aggregation profile in prolonged external ventricular support

^a Service de chirurgie cardiaque, Hôpital Henri Mondor, Créteil, France, Unité, Association Claude Bernard, Paris, France
^b Service d'hématologie biologique, Hôpital Lariboisière, Paris, France

Received for publication July 28, 2003; revisions received October 20, 2003; accepted for publication November 17, 2003.

^* Address for reprints: Rémi Houël, Institut Jacques Cartier, Adult Cardiac Surgery, 6 Avenue du Noyer Lambert, Massy 91300, France
remihouel{at}hotmail.com

BACKGROUND: Platelet function plays a major role in the understanding of thromboembolic events in prolonged mechanical support. We studied the platelet activation, platelet aggregation profile, and efficacy of aspirin in patients in whom an external ventricular assist device had been implanted.

PATIENTS AND METHODS: Fifteen patients were studied prospectively up to 6 weeks after implantation of the same type of ventricular assist device. Platelet function was studied weekly before daily aspirin administration. Aspirin efficacy was tested ex vivo by measuring platelet aggregation triggered by arachidonic acid. Flow cytometry was used to quantify the spontaneous and induced (adenosine diphosphate stimulation) expression of glycoproteins IIbß3, Ib, and CD62P on platelet membranes. The plasma levels of von Willebrand factor (von Willebrand factor activity and von Willebrand factor antigen) and fibrinogen were also determined.

RESULTS: Six of the 15 patients (26%) maintained an arachidonic acid-induced platelet aggregation despite daily aspirin treatment (250 mg). CD62P values remained increased during a 5-week postoperative period. Spontaneous levels of glycoproteins IIbß3 and Ib on platelet membranes remained within a normal range with a preserved reactivity. The plasma levels of fibrinogen and von Willebrand factor remained increased during the entire study period.

CONCLUSION: In patients with an implanted external ventricular assist device, the platelet activation profile displays a persistent activation with a preserved reactivity associated with a persistent high inflammatory state and endothelial activation.

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