Sildenafil Is Associated With Reduced Device Thrombosis and Ischemic Stroke Despite Low-Level Hemolysis on Heart Mate II Support

Circulation. Heart Failure
Omar SaeedUlrich P Jorde

Abstract

Persistent low-level hemolysis (LLH) during continuous-flow mechanical circulatory support is associated with subsequent thrombosis. Free hemoglobin from ongoing hemolysis scavenges nitric oxide (NO) to create an NO deficiency which can augment platelet function leading to a prothrombotic state. The phosphodiesterase-5 inhibitor, sildenafil, potentiates NO signaling to inhibit platelet function. Accordingly, we investigated the association of sildenafil administration and thrombotic events in patients with LLH during Heart Mate II support. A single-center review of all patients implanted with a Heart Mate II who survived to discharge (n=144). LLH was defined by a discharge lactate dehydrogenase level of 400 to 700 U/L. Patients were categorized as (1) LLH not on sildenafil, (2) LLH on sildenafil, (3) no LLH not on sildenafil, and (4) no LLH on sildenafil. Age, sex, platelet count, and mean platelet volume were similar between groups. Seventeen patients had either device thrombosis or ischemic stroke. Presence of LLH was associated with a greater risk of thrombosis (adjusted hazard ratio, 15; 95% confidence interval, 4.5-50; P<0.001 versus no LLH, not on sildenafil). This risk was reduced in patients with LLH on sildenafil (adju...Continue Reading

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Citations

Feb 15, 2018·Interactive Cardiovascular and Thoracic Surgery·Rashad ZayatLachmandath Tewarie
Jan 29, 2019·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Veraprapas KittipibulRandall C Starling
Jul 11, 2020·Journal of the American Heart Association·Gaurav Gulati, Michael S Kiernan
Sep 5, 2019·Journal of Artificial Organs : the Official Journal of the Japanese Society for Artificial Organs·Yorihiko MatsumotoTomoyuki Fujita
May 11, 2021·ESC Heart Failure·E Wilson Grandin, Jeffrey J Teuteberg
May 13, 2021·The International Journal of Artificial Organs·Douglas L JenningsVeli K Topkara

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