Use of multiplate electrode aggregometry for personalisonalisation of antiplatelet therapy in left ventricular assisst device patients

Type of funding sources: None.

The use of Left Ventricular Assist Devices (LVAD) has noticeably improved the survival for patients with advanced heart failure.  However, this treatment is associated with significant adverse effects. Personalisation of antiplatelet therapy is a key in control and reduction of bleeding/thromboembolic complications of this treatment. However, ISHLT and the manufacturer still recommend unified treatment of 150 mg of acetylsalicylic acid for all LVAD patients. In our centre, we base the treatment decision on clinical picture and patient’s responsiveness to antiplatelet therapy. 

The treatment of choice is acetylsalicylic acid in doses 37.5 mg (1 patient), 75 mg (25 patients) and 150 mg (33 patients). For patients unresponsive or intolerant to acetylsalicylic acid we use 75 mg of clopidogrel, currently 9 patients.  1 patient receives both, 75 mg clopidogrel and 75 mg acetylsalicylic acid. 

To gain a better understanding of the platelets function and patients" responses to antiplatelet therapy. In aim to reduce the prevalence of bleeding/thromboembolic related adverse events in LVAD patients, and therefore improve patients outcome.

In 2020, we decided to introduce a structured/test-based approach to antiplatelet therapy in this patients group. With the use of Multiplate Electrode Aggregometry (MEA) we have attempted to diagnose platelet disorders and monitor effectiveness of antiplatelet therapy. Based on MEA platlets inhibition test we were able to tailor the therapy. 

The retrospective audit was conducted with inclusion criteria;

1. Thromboembolic events include pump thrombosis and any other ischemic complications. Bleeding events contains gastrointestinal (GI) and central nervous system (CNS) events.

2. Any thromboembolic and bleeding events after starting antiplatelet therapy, in the first year after LVAD implantation

The tables below presents reduction in both thromboembolic and bleeding complications.

Presented data can be interpreted that, the test-based approach to antiplatelet therapy may be beneficial in limiting the adverse effects of LVAD therapy. However, it needs to be acknowledged that the observation was carried out on a small group of the patients, over a short period of time. Therefore, an extended period of observation is recommended to obtain further data.