Vol 28, No 5 (2021)
Original Article
Published online: 2019-03-14

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The role of hemostatic markers as venous stenosis or occlusion predictors following first transvenous cardiac device implantation

Andrzej Cacko1, Eliza Kozyra-Pydyś2, Monika Gawałko2, Grzegorz Opolski2, Marcin Grabowski2
Pubmed: 30912577
Cardiol J 2021;28(5):690-696.


Background: Among patients with an implanted cardiac implantable electronic device (CIED), ipsilateral upper extremity vein stenosis or occlusion (VSO) is observed more frequently than in the general population. However, there are no data available concerning the relationship between hemostatic markers (and their dynamics) and the occurrence of VSO. The aim of this study was to assess the predictive value of beta-thromboglobulin, the von Willebrand factor (vWF), fibrynogen and D-dimer for VSO development among first time CIED recipients.
Methods: This is a single-center, prospective study of consecutive first time CIED recipients without upper extremity VSO in baseline ultrasound examination. Biochemical data were collected from all the patients before CIED implantation (first measuring), up to 7 days subsequent (second measuring) and 6 months after the operation (third measuring). Primary endpoint was defined as the presence of upper extremity VSO at the implantation site during the ultrasound examination 6 months after the operation.
Results: The study included 71 patients (mean age 73.1 ± 10.5 years; 39 [55%] male). The incidence of VSO within 6-months follow up was 21.1%. Average concentrations of hemostatic markers increased significantly in all patients immediately after CIED implantation. Serial hemostatic marker concentrations were similar in patients who met or did not meet the primary endpoint, apart from vWF. The mean concentration was significantly elevated in the group of 15 patients who reached the primary endpoint (p = 0.032).
Conclusions: A significant increase in vWF concentration at 6 months post implantation may be a marker for VSO occurrence.

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  1. Raatikainen MJ, Arnar DO, Zeppenfeld K, et al. Statistics on the use of cardiac electronic devices and electrophysiological procedures in the European Society of Cardiology countries: 2014 report from the European Heart Rhythm Association. Europace. 2015; 17 Suppl 1: i1–75.
  2. Santini M, Di Fusco SA, Santini A, et al. Prevalence and predictor factors of severe venous obstruction after cardiovascular electronic device implantation. Europace. 2016; 18(8): 1220–1226.
  3. Jonik S, Grabowski M, Pietura R, et al. Successful removal of stented leads by using percutaneous approach. Heart Beat J. 2017; 2: 22–26.
  4. Rozmus G, Daubert JP, Huang DT, et al. Venous thrombosis and stenosis after implantation of pacemakers and defibrillators. J Interv Card Electrophysiol. 2005; 13(1): 9–19.
  5. Lickfett L, Bitzen A, Arepally A, et al. Incidence of venous obstruction following insertion of an implantable cardioverter defibrillator. A study of systematic contrast venography on patients presenting for their first elective ICD generator replacement. Europace. 2004; 6(1): 25–31.
  6. Pacholewicz J, Kuliczkowski W, Kaczmarski J, et al. Activated hemostatic biomarkers in patients with implanted left ventricle assist devices: are heparin and/or clopidogrel justified? Cardiology. 2015; 131(3): 172–176.
  7. Cacko A, Kozyra-Pydyś E, Gawałko M, et al. Predictors of venous stenosis or occlusion following first transvenous cardiac device implantation: Prospective observational study. J Vasc Access. 2018 [Epub ahead of print]: 1129729818815135.
  8. van Rooden CJ, Rosendaal FR, Barge RMY, et al. Central venous catheter related thrombosis in haematology patients and prediction of risk by screening with Doppler-ultrasound. Br J Haematol. 2003; 123(3): 507–512.
  9. Debourdeau P, Espié M, Chevret S, et al. Incidence, risk factors, and outcomes of central venous catheter-related thromboembolism in breast cancer patients: the CAVECCAS study. Cancer Med. 2017; 6(11): 2732–2744.
  10. Agarwal AK. Central vein stenosis: current concepts. Adv Chronic Kidney Dis. 2009; 16(5): 360–370.
  11. Chauhan AK, Kisucka J, Lamb CB, et al. von Willebrand factor and factor VIII are independently required to form stable occlusive thrombi in injured veins. Blood. 2007; 109(6): 2424–2429.
  12. Fu X, Chen J, Gallagher R, et al. Shear stress-induced unfolding of VWF accelerates oxidation of key methionine residues in the A1A2A3 region. Blood. 2011; 118(19): 5283–5291.
  13. Sharma G, Berger JS. Platelet activity and cardiovascular risk in apparently healthy individuals: a review of the data. J Thromb Thrombolysis. 2011; 32(2): 201–208.
  14. Migliorini A, Valenti R, Marcucci R, et al. High residual platelet reactivity after clopidogrel loading and long-term clinical outcome after drug-eluting stenting for unprotected left main coronary disease. Circulation. 2009; 120(22): 2214–2221.
  15. Plicner D, Ziętkiewicz M, Mazur P, et al. Beta-thromboglobulin as a marker of perioperative myocardial infarction in patients undergoing coronary artery bypass grafting following aspirin discontinuation. Platelets. 2014; 25(8): 603–607.
  16. Kubota Y, Alonso A, Heckbert SR, et al. Beta-thromboglobulin and incident cardiovascular disease risk: The Atherosclerosis Risk in Communities study. Thromb Res. 2017; 155: 116–120.
  17. van Rooden CJ, Molhoek SG, Rosendaal FR, et al. Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads. J Cardiovasc Electrophysiol. 2004; 15(11): 1258–1262.
  18. Zuber M, Huber P, Fricker U, et al. Assessment of the subclavian vein in patients with transvenous pacemaker leads. Pacing Clin Electrophysiol. 1998; 21(12): 2621–2630.