Mechanical circulatory assist (MCS) devices such as ventricular assist devices (VADs) are often employed to augment the function of failing ventricles in patients with advanced heart failure. However, these devices have limitations such as mechanical failure, infection, bleeding, and thrombosis. Patients on continuous-flow VADs undergo pharmacotherapy that includes both anticoagulant and antiplatelet prophylaxis such as aspirin. In the present study, the researchers aimed at establishing an in vitro method to compare the efficiency of pharmacotherapy with device design changes. The researchers developed an in vitro system using platelets isolated from donors that were circulated in a flow loop with prosthetic heart valves. Different conditions were compared using platelets isolated from patients treated with aspirin and platelets directly exposed to aspirin in vitro. Platelet activation state was measured and showed a reduction of platelet activation rate in both aspirin treatment in vitro and in vivo compared to untreated control. The study demonstrates the ability of a practical in vitro tool to test the antiplatelet efficacy of a drug and compare it to device modifications.
Comparative efficacy of in vitro and in vivo metabolized aspirin in the DeBakey ventricular assist device
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