Severe upper gastrointestinal bleeding in Heartmate II induced by acquired von Willebrand deficiency: anticoagulation management

The Annals of Thoracic Surgery
Sandro SpongaEric Charbonneau

Abstract

Patients treated with continuous flow assist devices may have increased bleeding tendencies due to an induced high molecular weight von Willebrand factor (VWF) multimer deficiency. We report a patient supported with a HeartMate II (Thoratec, Pleasanton, CA) who developed severe gastrointestinal bleeding refractory to conventional therapy and needing a total of 60 transfusions. After documenting the lack of large VWF multimers, suggestive of a defective platelet function, the patient was switched from aspirin to warfarin therapy (target international normalized ratio between 1.5 and 2.0). Three days after changing the anticoagulant regimen, the patient stopped bleeding and required no further transfusion.

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Citations

Nov 19, 2015·Expert Review of Hematology·Ulrich BuddeRita Dittmer
Nov 30, 2013·Cardiology Clinics·David A Baran, Abhishek Jaiswal
Oct 18, 2013·Seminars in Cardiothoracic and Vascular Anesthesia·Eugene A Hessel
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Jun 14, 2019·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Douglas L JenningsJean M Connors
Oct 27, 2015·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Wiley D TrussShajan Peter

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