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Risk of pump thrombosis and stroke in patients with continuous‐flow left ventricular assist devices and gastrointestinal bleeding
Author(s) -
Szymanski Thomas W.,
Weeks Phillip A.,
Patel Chandni J.,
Jezovnik Mateja K.,
Gulbis Brian,
Nathan Sriram S.,
Jumean Marwan F.,
Radovancevic Rajko,
Kar Biswajit,
Gregoric Igor D.
Publication year - 2020
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.13751
Subject(s) - medicine , stroke (engine) , gastrointestinal bleeding , thrombosis , incidence (geometry) , ventricular assist device , cardiology , antithrombotic , clinical endpoint , surgery , heart failure , randomized controlled trial , mechanical engineering , physics , engineering , optics
Gastrointestinal (GI) bleeding is a common complication following the placement of continuous‐flow left ventricular assist devices (LVADs) in patients with advanced heart failure. Secondary events arising as a result of GI bleeding have not been well‐described. Furthermore, attribution of these events to bleeding is complicated by the interruption or de‐intensification of antithrombotic therapy, while bleeding is controlled. The purpose of this study was to assess the incidence of pump thrombosis and ischemic stroke in patients with LVADs who experience GI bleeding, while on support. This was a single‐center, retrospective, observational cohort study of consecutive patients with LVADs implanted from January 2012 to June 2018. Patients were assigned to comparator groups based on whether they experienced GI bleeding while on LVAD support. The primary endpoint assessed was the composite of pump thrombosis or ischemic stroke. Secondary endpoints assessed included incidence of pump thrombosis or ischemic stroke. A total of 250 patients were included after screening for exclusion criteria, 101 (40.4%) in the GI bleeding group, and 149 (59.6%) in the non‐bleeding group. The incidence of pump thrombosis or ischemic stroke was not significantly greater in patients experiencing GI bleeding [23 (22.8%) vs. 21 (14.1%); P = .09]; however, the incidence of ischemic stroke alone was significantly greater [17 (16.8%) vs. 10 (6.7%); P = .01]. We conclude that GI bleeding in LVAD patients may be associated with a greater risk of ischemic stroke.