Platelet derived prothrombotic microparticles and adverse events in patients supported with Impella 5.5
Case series published in The International journal of artificial organs (2025)
Abstract
Platelet derived prothrombotic microparticles (MP) have been associated with hemocompatibility related adverse events in patients with continuous flow left ventricular assist devices; little is known with the contemporary Impella platform micro-axial flow pumps. Indeed, the extended duration of support provided by the Impella 5.5 calls for a specific evaluation. We report for the first time two patients in whom MP have been assessed during Impella 5.5 and concomitant dual antiplatelet and direct thrombin inhibitor therapy. Interestingly, the patients showed significantly different profile in overall MP release (peak: 78.1% vs 2.7%), which was not correlated to lactate dehydrogenase nor platelet count. The patient with the higher values suffered from minor stroke 4 days after pump removal, when systemic anticoagulation with Bivalirudin had been stopped. These preliminary data might envision a new predictor of hemocompatibility related adverse events in patients with Impella, and a rethinking on the post support antithrombotic strategy.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Two Impella 5.5 patients on dual antiplatelet therapy and bivalirudin showed markedly different platelet microparticle release (peaks 78.1% versus 2.7%); the higher-release patient had a minor stroke after bivalirudin was stopped.
Why This Matters for Hirudotherapy
This case report describes two patients on Impella 5.5 support with concomitant dual antiplatelet therapy and bivalirudin as systemic anticoagulation, finding markedly different profiles of platelet-derived prothrombotic microparticles (peak 78.1% vs 2.7%), with the higher-value patient suffering a minor stroke four days after pump removal when bivalirudin had been stopped. Its only link to leech therapy is that bivalirudin is a synthetic direct thrombin inhibitor structurally derived from hirudin, the signature anticoagulant of medicinal leech saliva. However, this study involves no leeches or leech therapy and is a two-patient case report, limiting generalizability.
Citation
Reference (Vancouver style)
D'Ettore N, Petruzza A, Cardinale A, Bensi T, Maj G, Ciriello MM, et al. Platelet derived prothrombotic microparticles and adverse events in patients supported with Impella 5.5. Int J Artif Organs. 2025;48(10):794-799. doi:10.1177/03913988251357199. PMID: 40717371
Bibliographic details (authors, volume, pages, DOI) are taken from the PubMed record.
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