Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients

Abstract

Aims Left ventricular assist devices (LVADs) have reduced the mortality of patients with advanced heart failure both as bridge-to-transplant and as destination therapy. However, LVADs are associated with various complications, including bleedings, which affect the prognosis. The aim of the study was to explore the prevalence, management, and outcomes of haemorrhagic adverse events in LVAD recipients. Methods and resultsWe conducted a retrospective, single-centre, cohort study including all patients who received an LVAD from January 2008 to December 2019 in our tertiary centre (Rangueil University Hospital, Toulouse, France). Bleeding events, death, and heart transplantation were collected from electronic medical files. Eighty-eight patients were included, and 43 (49%) presented at least one bleeding event. Gastrointestinal (GI) bleeding was the most frequent (n = 21, 24%), followed by epistaxis (n = 12, 14%) and intracranial haemorrhage (n = 9, 10%). Bleeding events were associated with increased mortality [hazard ratio (HR) 3.8, 95% confidence interval (CI) 1.5-9.3, P < 0.01], particularly in case of intracranial haemorrhage (HR 14.6, 95% CI 4.2-51.1, P < 0.0001). GI bleedings were associated with a trend towards increased mortality (HR 3.0, 95% CI 0.9-9.3, P = 0.05). Each bleeding episode multiplied the risk of death by 1.8 (95% CI 1.2-2.7, P < 0.01). Finally, only early bleedings (<9 months post-implantation) had an impact on mortality (HR 4.2, 95% CI 1.6-11.1, P < 0.01). Therapeutic management was mainly based on temporary interruption of anticoagulation and permanent interruption of antiplatelet therapy. Invasive management was rarely performed. Conclusions Haemorrhagic events in LVAD recipients are frequent and associated with increased mortality. GI bleedings are the most frequent, and intracranial haemorrhages the most associated with mortality. Management remains empirical requiring more research.

Decreased Platelet Specific Receptor Expression of P-Selectin and GPIIb/IIIa Predict Future Non-Surgical Bleeding in Patients after Left Ventricular Assist Device Implantation

“…In addition, the timing of the first bleeding event was not limited to a distinct period after LVAD implantation. This is consistent with other studies, in which bleeding events range from the early postoperative phase (≤3 month) until 2 years after LVAD implantation [ 2 , 21 ]. Furthermore, the postoperative anticoagulation regime was comparable between the bleeder and the non-bleeder group.…”

“…Left ventricular assist device (LVAD) implantation is an effective therapeutic option for patients with end-stage heart failure [ 1 , 2 ]. Despite the clinical outcomes of prolonged survival and improved quality of life, LVAD usage is associated with various LVAD-related adverse events such as infections, pump failure, thrombosis or non-surgical bleedings (NSB) [ 2 ].…”

“…Left ventricular assist device (LVAD) implantation is an effective therapeutic option for patients with end-stage heart failure [ 1 , 2 ]. Despite the clinical outcomes of prolonged survival and improved quality of life, LVAD usage is associated with various LVAD-related adverse events such as infections, pump failure, thrombosis or non-surgical bleedings (NSB) [ 2 ]. The incidence of NSB is defined as intracranial hemorrhage events requiring two units of packed red blood cells, or death from bleeding occurring > 7 days after LVAD implantation, and was reported in 41% of LVAD patients with 0.48 events per patient year [ 3 ].…”