Wednesday, December 9, 2015
Q: Which hematologic condition is expected after insertion of Ventricular Assisted Device (VAD) post-operatively?
Answer: Acquired von Willebrand disease (aVWD)
High shear stress of pumps of VADs causes proteolysis of large VWF multimers, resulting in aVWD. It may cause life threatening bleeding. It is so common that all patients with continuous flow VADs should be assumed to have aVWD. Diagnosis can be documented by specific tests though not required. Treatment include desmopressin (DDAVP), VWF concentrates, recombinant factor VIIa, antifibrinolytic agents, and supportive treatment with transfusions.
Heilmann C, Geisen U, Beyersdorf F, et al. Acquired Von Willebrand syndrome is an early-onset problem in ventricular assist device patients. Eur J Cardiothorac Surg 2011; 40:1328.