CAUSES AND MECHANISMS OF THE DEVELOPMENT OF HEMATOLOGICAL COMPLICATIONS IN PATIENTS WITH AN IMPLANTED MECHANICAL DEVICE OF THE LEFT VENTRICLE
Introduction. Chronic heart failure is one of the main health problems of the Republic of Kazakhstan, which requires heart transplantation (HT) to extend the patient's life. A heart transplant is not available to every patient due to the limited number of heart donors. Today, an alternative method of the HT is the implantation of a left ventricular assist device (LVAD), which helps patients survive before transplantation. However, treatment with LVAD causes risk of thrombosis and bleeding in patients with heart failure.
Aim. To do research about mechanisms of the development of the hematological complications and the causes in patients with an implanted left ventricular assist devices (LVAD) according to the literature review.
Research strategy. Search for scientific publications was carried out in search engines: Web of Science, ResearchGate, PubMed, Google Academy, elibrary.ru. Criteria for inclusion of publications in the literature review are defined as publications with the full text, in Russian and English, with statistically verified conclusions. Of 73 literary sources, 54 articles were selected as analytical material for this article.
Results. The reason of thrombosis and bleeding is the presence of a high non-physiological shear stress (NPSS) of the LVAD rotor, which rotates in the range of 5000 to 12000 rpm. High shear stress causes damage of the platelet’s glycoprotein receptors (GPIbα, GPVI and GPIIb/IIIa), the coagulation system, impaired hemostasis, and the degradation of the multimers of Von Willebrand Factor. Nowadays, a perspective way in this area is the study of genetic polymorphism of the platelet receptors, which can affect the reduction of the risk of thrombosis and bleeding during LVAD implantation. Mutations of the genes encoding receptors can lead to the changes in the platelet function, thereby affecting to the outcome of the treatment with a mechanical LVAD device.
Conclusions. Von Willebrand factors and glycoprotein receptors on the platelet surface are very important for maintaining a balanced hemostasis process for prevention of the bleeding and thrombosis formation in patients with an implanted LVAD devices.
Madina R. Zhalbinova 1,2, https://orcid.org/0000-0001-9704-8913
Saule E. Rakhimova 1, http://orcid.org/0000-0002-8245-2400
Makhabbat S.Bekbosynova 3, Saltanat A. Andosova 3,
Ainur R. Akilzhanova 1,2, http://orcid.org/0000-0001-6161-8355
1 National Laboratory Astana, Nazarbayev University, Nur-Sultan city, Republic of Kazakhstan;
2 L.N. Gumilyov Eurasian National University, Nur-Sultan city, Republic of Kazakhstan;
3 JSC “National Research Cardiac Surgery Center”, Nur-Sultan, Kazakhstan.
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Zhalbinova M.R., Rakhimova S.E., Bekbosynova M.S., Andosova S.A., Akilzhanova A.R. Causes and mechanisms of the development of hematological complications in patients with an implanted mechanical device of the left ventricle // Nauka i Zdravookhranenie [Science & Healthcare]. 2020, (Vol.22) 1, pp. 5-16. doi:10.34689/SH.2020.22.1.001Related publications:
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