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Mechanical circulatory support is associated with loss of platelet receptors glycoprotein Ibα and glycoprotein VI
Author(s) -
Lukito P.,
Wong A.,
Jing J.,
Arthur J. F.,
Marasco S. F.,
Murphy D. A.,
Bergin P. J.,
Shaw J. A.,
Collecutt M.,
Andrews R. K.,
Gardiner E. E.,
Davis A. K.
Publication year - 2016
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13497
Subject(s) - gpvi , von willebrand disease , platelet , von willebrand factor , medicine , platelet membrane glycoprotein , extracorporeal membrane oxygenation , platelet activation , receptor , platelet glycoprotein gpib ix complex , coagulation , glycoprotein ib , immunology , cardiology
Essentials Relationship of acquired von Willebrand disease (VWD) and platelet dysfunction is explored. Patients with ventricular assist devices and on extracorporeal membrane oxygenation are investigated. Acquired VWD and platelet receptor shedding is demonstrated in the majority of patients. Loss of platelet adhesion receptors glycoprotein (GP) Ibα and GPVI may increase bleeding risk.Summary Background Ventricular assist devices ( VAD s) and extracorporeal membrane oxygenation ( ECMO ) are associated with bleeding that is not fully explained by anticoagulant or antiplatelet use. Exposure of platelets to elevated shear in vitro leads to increased shedding. Objectives To investigate whether loss of platelet receptors occurs in vivo , and the relationship with acquired von Willebrand syndrome ( AVWS ). Methods Platelet counts, coagulation tests and von Willebrand factor ( VWF ) analyses were performed on samples from 21 continuous flow VAD ( CF ‐ VAD ), 20 ECMO , 12 heart failure and seven aortic stenosis patients. Levels of platelet receptors were measured by flow cytometry or ELISA . Results The loss of high molecular weight VWF multimers was observed in 18 of 19 CF ‐ VAD and 14 of 20 ECMO patients, consistent with AVWS . Platelet receptor shedding was demonstrated by elevated soluble glycoprotein ( GP ) VI levels in plasma and significantly reduced surface GPI bα and GPVI levels in CF ‐ VAD and ECMO patients as compared with healthy donors. Platelet receptor levels were also significantly reduced in heart failure patients. Conclusions These data link AVWS and increased platelet receptor shedding in patients with CF ‐ VAD s or ECMO for the first time. Loss of the platelet surface receptors GPI bα and GPVI in heart failure, CF ‐ VAD and ECMO patients may contribute to ablated platelet adhesion/activation, and limit thrombus formation under high/pathologic shear conditions.