Prevention and Treatment of Thrombotic and Hemorrhagic Complications in Patients Supported by Continuous-Flow Left Ventricular Assist Devices

Abstract

Left ventricular assist devices (LVADs) are now widely used for the management of end-stage heart failure. Unfortunately, in spite of the indisputable positive impact LVADs have on patients, the frequency and severity of complications are limitations of this therapy. Stroke, pump thrombosis, and gastrointestinal bleeding are among the most serious and frequent complications in these patients. The balance between hemorrhagic and thrombotic complications in patients supported with CF-LVAD is difficult as most patients do not necessarily fit a "bleeder" or a "clotter" profile but rather move from one side to the other of the thrombotic/bleeding spectrum. Further research is necessary to better understand the risk factors and mechanisms involved in the development of these complications.

Total Joint Arthroplasty in Patients With an Implanted Left Ventricular Assist Device

“…[ 19 ] with mortality rates of 1.1%, 0.9%, 2.2%, and 4.3% for primary THA and TKA and revision THA and TKA procedures, respectively. Patients supported by an LVAD have been shown to have 20-fold the incidence of stroke compared to the general population, and it is significantly higher than that observed in other cardiovascular conditions such as atrial fibrillation or mechanical heart valves [ 20 ]. Similarly, Walton et al.…”

Antiplatelet and anticoagulation strategies for left ventricular assist devices

“…The freedom to first occurrence of major AE (including infection, device malfunction, stroke, bleeding or death) at 6 months postimplantation is approximately 40% (10). The most frequent AEs are bleeding and thromboembolism episodes (11). AEs in LVAD patients lead to recurrent hospitalizations with an estimated 218 hospital admissions per 100 patients at 1 year post-implant (12).…”

“…PT risk is device dependent, and Heartmate III has a significantly more favorable PT profile than Heartmate II (1.4% vs. 13.9% at 2 years) (4). Small case series have reported variable degrees of success in treating PT with augmented or alternate anticoagulation, antiplatelet therapies, and thrombolysis (11,102). Larger and aggregate studies report approximately 50% success of medical therapy in resolving PT, with similar success rates in Heartmate II and HVAD.…”

Detection of thrombosis in a magnetically levitated blood pump by vibrational excitation of the impeller

“…Such VADs utilize the hydrodynamic bearings, for example, HVAD (Medtronic Inc., Minneapolis, MN, USA), or magnetic bearings, for example, HeartMate 3 (Abbott Laboratories, Chicago, IL, USA), for levitation of the impeller and have been in clinical use worldwide . Although much technical progress has been made in VADs, pump thrombosis and stroke are still serious issues in this field . For example, recent research has shown that the rate of thrombosis observed in HVAD for adult patients is 8.1% and that for pediatric patients is 30.8% …”