Thorac Cardiovasc Surg 2013; 61 - OP54
DOI: 10.1055/s-0032-1332293

Aspirin and clopidogrel non-responder in patients with a left ventricular assist device

J Riebandt 1, S Mahr 1, T Haberl 1, S Panzer 2, H Schima 3, G Laufer 1, D Zimpfer 1
  • 1Medical University of Vienna, Department of Cardiac Surgery, Vienna, Austria
  • 2Medical University of Vienna, Department of Blood Group Serology and Transfusion Medicine, Vienna, Austria
  • 3Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria

Objectives: Thromboembolic complications are a deleterious adverse event after left ventricular assist device (LVAD) implantation. Because of individual responsiveness to antiplatelet treatment with the COX-inhibitor aspirin and P2Y12-inhibitor clopidogrel, personalized treatment based on platelet function testing may significantly reduce thromboembolic complications in LVAD patients. The present study was designed to define the frequency of aspirin and clopidogrel incidence in LVAD patients.

Methods: Responsiveness to antiplatelet treatment was prospectively assessed by multiple electrode aggregrometry in 31 LVAD patients (HVAD® n = 24, HeartMateII® n = 7). Twenty-five of them received the standard daily dose of 100 mg aspirin, three were treated with 200 mg aspirin, one patient with 75 mg clopidogrel and two with a combination of both substances. The daily dosage was doubled in non-responders and patients were tested again after two weeks.

Results: Multiple electrode aggregrometry detected non-responsiveness to the initial antiplatelet regimen in two patients (6.5%) and only moderate responsiveness in one patient (3.2%). The remaining 28 patients (90.3%) showed a good in vitro efficacy of the antiplatelet therapy. An adaption of the antiplatelet therapy by doubling the daily dosage led to adequate platelet inhibition, as revealed by multiple electrode aggregrometry, two weeks after treatment change.

Conclusion: As shown by objective measures, non-responsiveness to antiplatelet therapy is a common finding in patients after left ventricular assist device implantation. Therefore, personalized treatment according to the platelet function testing may reduce the incidence of thromboembolic complications.