Ann Thorac Surg 2006;82:1167
© 2006 The Society of Thoracic Surgeons
Correspondence
Impact of PlA Polymorphism of Platelet GP IIb/IIIa Receptors on Clinical Course During Long-Term LVAD Support is Independent of Type of LVAD
Evgenij V. Potapov, MD,
Roland Hetzer, MD, PhD
Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
(Email: potapov{at}dhzb.de).
To the Editor:
In our previous study we showed an association of the PlA A1A1 genotype with bleeding and a trend toward an association of A1A2 with thromboembolic events during long-term mechanical circulatory support [1]. However, one of the limiting factors was the use of different ventricular assist devices (VADs) in the study, ie the pulsatile Novacor LVAS (WorldHeart Inc, Oakland, CA) and BerlinHeart Excor (Berlin Heart AG, Berlin, Germany) and the axial flow MicroMed DeBakey System (MicroMed Technology, Inc, Houston, TX). To avoid the impact of the device type, we have now analyzed the relationship between PlA polymorphism and postoperative thromboembolic events in 31 patients receiving aspirin or clopidogrel, or both, as part of the anticoagulation regime and supported with the axial flow BerlinHeart INCOR VAD (Berlin Heart AG) only. Four of 23 patients with the A1A1 genotype presented bleeding events, whereas none of the 8 patients with the A1A2 genotype did so. The two groups received similar doses of aspirin or clopidogrel, or both. These results are in accordance with our previously published data in which none of the 10 patients with the A1A2 genotype suffered a bleeding event. After the first study, we applied less aggressive antiplatelet therapy in patients supported with the BerlinHeart INCOR LVAD (Berlin Heart AG), and this led to a marked decrease of bleeding complications in these patients (17% vs 39%). The incidence of thromboembolic events did not differ from that found in the previous study. Therefore, first the PlA polymorphism may influence the type of complications with greater impact than the type of VAD used. Second, the addition of clopidogrel does not seem to decrease the incidence of thromboembolic events.
These data support the importance of determining the PlA polymorphism and adjusting the anticoagulation regime accordingly.
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References
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- Potapov EV, Ignatenko S, Nasseri BA, et al. Clinical significance of PlA polymorphism of platelet GP IIb/IIIa receptors during long-term VAD support Ann Thorac Surg 2004;77:869-874discussion 874.[Abstract/Free Full Text]
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