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Bleeding and thrombotic complications and their impact on mortality in patients supported with left ventricular assist device for cardiogenic shock.
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- Author(s): Bekono-Nessah, Ingrid; Rosenburg, Alex; Bowles, Christopher T; Riesgo-Gil, Fernando; Stock, Ulrich; Szydlo, Richard R; Laffan, Mike; Arachchillage, Deepa J
- Source:
Perfusion. Nov2023, Vol. 38 Issue 8, p1670-1681. 12p. - Source:
- Additional Information
- Subject Terms: THROMBOSIS risk factors; THROMBOSIS; STATISTICS; PATIENT aftercare; SCIENTIFIC observation; CONFIDENCE intervals; MEDICAL device removal; AGE distribution; LOG-rank test; MULTIVARIATE analysis; BLOOD transfusion; HEART assist devices; RETROSPECTIVE studies; HEMOSTASIS; ANTICOAGULANTS; TERTIARY care; REGRESSION analysis; MULTIPLE organ failure; RISK assessment; TREATMENT effectiveness; CARDIOGENIC shock; ASPIRIN; ANEMIA; RESEARCH funding; DESCRIPTIVE statistics; KAPLAN-Meier estimator; SURVIVAL analysis (Biometry); MECHANICAL hearts; DATA analysis software; DEATH; HEMORRHAGE; PROBABILITY theory; LONGITUDINAL method; PROPORTIONAL hazards models; DISEASE complications
- Subject Terms:
- Abstract: Introduction: Thrombosis and bleeding are major complications in patients supported with left ventricular assist devices (LVADs). We aimed to assess the incidence of bleeding and thrombosis in patients supported with a HeartWare left ventricular assist device (HVAD), their predictive factors and their impact on mortality. Methods: A single centre retrospective observational study of patients supported with HVAD over 5 years from January 2015 to October 2020. Results: A total 139 patients (median age 52.5, 72.1% male) were included for analysis. The probability of 1-year survival was 73.1%. Advanced age (>60 years) and EuroSCORE II score (>20%) were independently associated with reduced survival. Major bleeding and thrombosis occurred in 46.8% and 35.3% respectively. Secondary mechanical circulatory support (MCS) increased likelihood of experiencing major bleeding (HR: 2.76, 95%1.65–4.62, p < 0.0001) whilst patients receiving aspirin were protected from bleeding and thrombosis (HR: 0.34 95% CI 0.19–0.58, p < 0.001). Pre-operative anaemia (HR: 3.02, 95% CI: 1.6–5.7, p = 0.014) and use of a secondary MCS device (HR: 2.78, 95% CI: 1.2–6.3, p = 0.001) were associated with an increased risk of thrombosis. Patients with any major bleeding (with or without thrombosis) had a 7.68-fold (95% CI 3.5–16.8) increased risk of death compared to those without. In contrast, 'thrombosis only' patients had 4.23-fold (95% CI 1.8–10.2) increased risk of death compared to those without thrombosis. The risk of mortality was increased in patients with any thrombosis and the risk of death was highest in patients with major bleeding and thrombosis (HR: 16.49 [95% CI 7.7–35.3]). Conclusions: Major bleeding and thrombosis significantly increase the 1-year mortality. Optimal perioperative haemostasis and anticoagulation remains crucial in patients supported with HVAD. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Perfusion is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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