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Thromb Haemost 2023; 123(03): 336-346
DOI: 10.1055/a-1983-0676
Stroke, Systemic or Venous Thromboembolism

Impact of ABO Blood Group on Thromboembolic and Bleeding Complications in Patients with Left Ventricular Assist Devices

Maximilian Tscharre 
1   Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
2   Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Franziska Wittmann
3   Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Daniela Kitzmantl
2   Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Thomas Schlöglhofer
3   Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Philip Cichra
3   Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Silvia Lee
2   Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Beate Eichelberger
4   Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
,
Patricia P. Wadowski
2   Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Günther Laufer
3   Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Dominik Wiedemann
3   Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Simon Panzer
4   Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
,
Daniel Zimpfer
3   Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
,
Thomas Gremmel
2   Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
5   Department of Internal Medicine I, Cardiology and Intensive Care Medicine, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
6   Institute of Cardiovascular Pharmacotherapy and Interventional Cardiology, Karl Landsteiner Society, St. Pölten, Austria
› Author Affiliations Funding This work was supported by the “Austrian Heart Fund” grant number 202003.
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Abstract

Background The ABO blood group system is linked to hemostasis via its relationship with von Willebrand factor (VWF) and factor VIII (FVIII). In the current study, we investigated the association of the ABO system with clinical outcomes as well as VWF and platelet function in patients with left ventricular assist devices (LVADs).

Methods Bleeding and thromboembolic complications were assessed in 111 patients during 1 year after LVAD implantation. In 67 LVAD patients, VWF antigen, VWF activity, VWF ristocetin cofactor, VWF collagen-binding, and FVIII activity were assessed. Platelet surface P-selectin and activated glycoprotein IIb/IIIa were determined by flow cytometry, and soluble P-selectin was measured with an enzyme-linked immunoassay. Platelet aggregation was assessed by light transmission and impedance aggregometry.

Results Thirty-six patients (32.4%) experienced a bleeding and 22 patients (19.8%) a thromboembolic event. In univariate analyses, patients with blood group O had numerically more bleeding complications and less thromboembolic events as compared to patients with blood group non-O (both p ≥ 0.05). After multivariable adjustment, blood group O was significantly associated with a higher risk of bleeding (hazard ratio 2.42 [95% confidence interval 1.03–5.70], p = 0.044) but not linked to thromboembolic complications.

Conclusion Patients with blood group O had significantly lower levels of VWF and FVIII (all p < 0.05), whereas P-selectin expression in response to thrombin-receptor activating peptide and soluble P-selectin were higher as compared to patients with blood group non-O (both p < 0.05). LVAD patients with blood group O are at an increased bleeding risk, potentially due to lower VWF and FVIII levels.

Keywords

left ventricular assist device - ABO group system - von Willebrand factor - bleeding complications - thromboembolic complications


Publication History

Received: 30 July 2022

Accepted: 02 November 2022

Accepted Manuscript online:
19 November 2022

Article published online:
30 December 2022

© 2022. Thieme. All rights reserved.

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