Platelet derived prothrombotic microparticles and adverse events in patients supported with Impella 5.5

Abstract

Platelet derived prothrombotic microparticles (MP) have been associated with hemocompatibility related adverse events in patients with continuous flow left ventricular assist devices; little is known with the contemporary Impella platform micro-axial flow pumps. Indeed, the extended duration of support provided by the Impella 5.5 calls for a specific evaluation. We report for the first time two patients in whom MP have been assessed during Impella 5.5 and concomitant dual antiplatelet and direct thrombin inhibitor therapy. Interestingly, the patients showed significantly different profile in overall MP release (peak: 78.1% vs 2.7%), which was not correlated to lactate dehydrogenase nor platelet count. The patient with the higher values suffered from minor stroke 4 days after pump removal, when systemic anticoagulation with Bivalirudin had been stopped. These preliminary data might envision a new predictor of hemocompatibility related adverse events in patients with Impella, and a rethinking on the post support antithrombotic strategy.