Titre
Les nouvelles générations d’assistance ventriculaire sont- elles associées avec un risque plus faible de saignement gastro- intestinaux ?
Type
mémoire de master/maîtrise/licence
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Auteur(s)
BOLLE, N.
Auteure/Auteur
Directrices/directeurs
TOZZI, P.
Directeur⸱rice
Liens vers les personnes
Liens vers les unités
Faculté
Université de Lausanne, Faculté de biologie et médecine
Statut éditorial
Accepté
Date de publication
2023
Nombre de pages
22
Langue
français
Résumé
Introduction: Heart failure (HF) is a prevalent and serious condition that affects the heart's structure and function, leading to hospitalization and possibly death. Left ventricular assist devices (LVADs) have emerged as a crucial treatment for end-stage HF when other therapies failed. However, LVADs come with complications, including gastrointestinal (GI) bleeding. Here, we conducted a meta-analysis to examine the association between continuous flow LVADs and GI bleeding, focusing on blood parameters linked to intestinal angiodysplasias and acquired Von Willebrand syndrome (AVWS). Platelet levels, VWF Antigen levels, VWF activity, and International Normalized Ratio (INR) are evaluated as potential predictors of post- implantation GI bleeding. The study aims to develop a risk stratification score to identify high-risk patients after LVAD implantation.
Methods: A systematic literature search was conducted in OVID and EMBASE databases. We selected studies published from January 2000 to October 2022, in English, multicentered in nature, focusing on GI bleeding in LVAD patients. Data on bleeding and non-bleeding patient groups, sample size, LVAD type, and pre- and post- implantation blood parameter values were collected. Statistical analysis involved mean calculation and forest plots using Excel and R Studio.
Results: The Crow et al. study showed significantly higher VWFAg levels in patients without bleeding compared to the Joyce et al. and Bansal et al. studies. Pre-implantation VWFAg levels in patients with bleeding were above the normal range in the Joyce et al. study but like those without bleeding in the Bansal et al. study. INR values were consistent across studies, indicating effective anticoagulant therapy in patients without bleeding. VWFAct levels did not show a clear trend in patients without bleeding, but the Joyce et al. study reported significantly lower VWFAct levels in patients with bleeding compared to those without bleeding. The Bansal et al. study showed lower VWFAct levels in patients with bleeding. Platelet counts remained relatively consistent in patients without bleeding. Post-implantation VWFAg levels were significantly higher in the Joyce et al. study compared to the Bansal et al. study in patients with bleeding.
Discussion: Variations in VWFAg and VWFAct levels between studies, particularly in patients with bleeding, could be attributed to different LVAD models and inflammation in advanced heart failure. Post-implantation VWFAg and VWFAct levels were unexpectedly lower than pre-implantation levels, requiring further investigation. INR values remained consistent, highlighting the importance of anticoagulant therapy. Platelet counts showed no clear correlation with bleeding risk. HMWM vWF multimers deficiency was observed in bleeding patients, but its role in bleeding origin requires further exploration.
Conclusion: This meta-analysis confirms the intricate relationship between VWFAg, VWFAct, INR, platelet count, HMWM vWF multimers, and blood type in LVAD patients. More research is needed to understand the underlying mechanisms and develop strategies for predicting and managing bleeding complications in this population.
Methods: A systematic literature search was conducted in OVID and EMBASE databases. We selected studies published from January 2000 to October 2022, in English, multicentered in nature, focusing on GI bleeding in LVAD patients. Data on bleeding and non-bleeding patient groups, sample size, LVAD type, and pre- and post- implantation blood parameter values were collected. Statistical analysis involved mean calculation and forest plots using Excel and R Studio.
Results: The Crow et al. study showed significantly higher VWFAg levels in patients without bleeding compared to the Joyce et al. and Bansal et al. studies. Pre-implantation VWFAg levels in patients with bleeding were above the normal range in the Joyce et al. study but like those without bleeding in the Bansal et al. study. INR values were consistent across studies, indicating effective anticoagulant therapy in patients without bleeding. VWFAct levels did not show a clear trend in patients without bleeding, but the Joyce et al. study reported significantly lower VWFAct levels in patients with bleeding compared to those without bleeding. The Bansal et al. study showed lower VWFAct levels in patients with bleeding. Platelet counts remained relatively consistent in patients without bleeding. Post-implantation VWFAg levels were significantly higher in the Joyce et al. study compared to the Bansal et al. study in patients with bleeding.
Discussion: Variations in VWFAg and VWFAct levels between studies, particularly in patients with bleeding, could be attributed to different LVAD models and inflammation in advanced heart failure. Post-implantation VWFAg and VWFAct levels were unexpectedly lower than pre-implantation levels, requiring further investigation. INR values remained consistent, highlighting the importance of anticoagulant therapy. Platelet counts showed no clear correlation with bleeding risk. HMWM vWF multimers deficiency was observed in bleeding patients, but its role in bleeding origin requires further exploration.
Conclusion: This meta-analysis confirms the intricate relationship between VWFAg, VWFAct, INR, platelet count, HMWM vWF multimers, and blood type in LVAD patients. More research is needed to understand the underlying mechanisms and develop strategies for predicting and managing bleeding complications in this population.
PID Serval
serval:BIB_AEF7150B7BC4
Date de création
2024-08-09T12:36:19.168Z
Date de création dans IRIS
2025-05-21T00:40:59Z
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Nom
Mémoire no 10044 Mme Bolle.pdf
Version du manuscrit
imprimatur
Taille
1.49 MB
Format
Adobe PDF
PID Serval
serval:BIB_AEF7150B7BC4.P001
Somme de contrôle
(MD5):3a9581a672a6461fa5c4777e1da33bf3