Platelet derived prothrombotic microparticles and adverse events in patients supported with Impella 5.5
Case report 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.
Resumen
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.
Por qué esto importa para la hirudoterapia
Este caso clínico describe a dos pacientes con soporte de Impella 5.5 que recibieron terapia antiplaquetaria dual concomitante y bivalirudina como anticoagulación sistémica, hallando perfiles marcadamente diferentes de micropartículas protrombóticas derivadas de plaquetas (pico de 78,1 % frente a 2,7 %), sufriendo la paciente con el valor más alto un accidente cerebrovascular menor cuatro días después de la retirada de la bomba, una vez suspendida la bivalirudina. La relevancia para el ámbito de ASH es indirecta: la bivalirudina es un inhibidor directo sintético de la trombina, derivado estructuralmente de la hirudina, el anticoagulante característico de la saliva de la sanguijuela medicinal. Sin embargo, este estudio no involucra sanguijuelas ni terapia con sanguijuelas y se trata de un caso clínico de dos pacientes, lo que limita su generalizabilidad.
Citación
Platelet derived prothrombotic microparticles and adverse events in patients supported with Impella 5.5
D'Ettore N et al. · The International journal of artificial organs, 2025
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026