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Incidence and Risk Factor Analysis for Gastrointestinal Bleeding and Pump Thrombosis in Left Ventricular Assist Device Recipients
Author(s) -
Lopilato Alex C.,
Doligalski Christina Teeter,
Caldeira Christiano
Publication year - 2015
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12471
Subject(s) - medicine , incidence (geometry) , thrombosis , risk factor , gastrointestinal bleeding , single center , cohort , retrospective cohort study , cardiology , gastroenterology , surgery , optics , physics
Left ventricular assist devices ( LVADs ) are associated with hemostatic complications. We describe the incidence and risk factors for gastrointestinal bleeding ( GIB ) and pump thrombosis ( PT ) to optimize patient selection/management. An IRB ‐approved retrospective review of first LVAD implants between October 1, 2011 and September 30, 2013 at a single center was conducted. Endpoints included epidemiological and risk factor analyses for GIB and PT . Descriptive statistics, chi‐squared, and t ‐tests were used. Sixty‐four patients received continuous‐flow LVAD s. The 12‐month incidence of GIB and PT was 23.4% and 12.5%. Time to first GIB was 72.6 days (9–160). The 1‐, 3‐, and 6‐month rate of PT was 1.6%, 6.25%, and 12.5%, respectively. All PT required pump exchange. Females (50% vs. 16%, P = 0.026) and patients without antiplatelet therapy (12.5% vs. 50%, P = 0.046) were at increased risk of PT . No pre‐implant comorbidities were associated with PT . Infection was not identified as a risk factor in our cohort (25% vs. 51.8%, P = 0.156). Mean INR preceding event was not different from nonevent patients (2.1 vs. 2.24, P = 0.24). Regarding biomarkers preceding event, elevated plasma free hemoglobin ( pfHg ) did not reach significance (75% vs. 58%, P = 0.383) while lactate dehydrogenase was elevated significantly (744 vs. 298, P < 0.001). Receiver operating characteristic ( ROC ) analysis demonstrated that an LDH of >500 was highly sensitive and specific for PT . No pre‐implant factors were associated with GIB . Post‐implant risk factors for GIB included infection (80% vs. 38.8%, P = 0.005) and infrequent elevations in pfHg (13.3% vs. 63.3%, P < 0.001). Increased pump speed as a GIB risk factor was confirmed (HeartMate II 9560 rpm vs. 9490 rpm, P < 0.001; HeartWare 2949 rpm vs. 2710 rpm, P < 0.001). Anticoagulation/antiplatelet therapy did not affect GIB : mean INR preceding event was not different from nonevent patients (2.21 vs. 2.27, P = 0.67) and antiplatelet use was not different (46.7% vs. 46.9%, P = 0.985). LVADs are associated with early hemostatic‐related morbidity. Few pre‐implantation risk factors were elucidated; however, post‐implantation factors including antiplatelet therapy, infection, and pump speed were identified.