Issn Print: 1058-2916

Publication Date: 2003/03/01


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CLINICAL SIGNIFICANCE OF PIA POLYMORPHISM OF PLATELET GP IIb/IIIa RECEPTORS DURING LONG-TERM VAD SUPPORT

E. V. Potapov; S. Ignatenko; B. A. Nasseri; M. Loebe; M. Bettmann; V. Regitz-Zagrosek; R. Hetzer

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Author Information: Dept. of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany

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Background Bleeding and thromboembolic events remain major complications after the implantation of VADs. Genetic polymorphism of platelet glycoprotein IIb/IIIa may contribute to the development of complications.
Methods The PIA genotype was determined in 41 consecutive VAD patients who received anticoagulation with phenprocoumon, ASS and dipirydamol. Pulsatile VADs of the type Novacor and Berlin Heart were implanted in 28 patients and the axial flow MicroMed DeBakey VAD in 13. The relationship between the PIA genotype, the anticoagulation regime and bleeding and thromboembolic events was analyzed.
Results There are no differences between patients with the A1A1 and A1A2 genotype regarding demographic characteristics. The follow-up time was in A1A1 group 239 and in the A1A2 group 442 days. The INR, results of platelet activation tests and doses of ASS and dipirydamol before events were similar in both groups. Patients with the A1A1 genotype developed more bleeding complications (42% vs. 0%, p=0.017), while A1A2 genotype patients showed more thromboembolic events (40% vs. 10%, p= 0.047). Multivariate analysis showed no impact of type of VAD and significant impact only of the genotype (p<0.05) on the development of postoperative complications.
Conclusion In patients with VADs determination of PIA polymorphism and corresponding adjustment of anticoagulation regime may lead to a reduction of bleeding and thromboembolic complications.
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