Incidence and Risk Factor Analysis for Gastrointestinal Bleeding and Pump Thrombosis in Left Ventricular Assist Device Recipients

2015 ◽  
Vol 39 (11) ◽  
pp. 939-944 ◽  
Author(s):  
Alex C. Lopilato ◽  
Christina Teeter Doligalski ◽  
Christiano Caldeira
Keyword(s):  
Factor Analysis ◽  
Risk Factor ◽  
Gastrointestinal Bleeding ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Pump Thrombosis ◽  
Left Ventricular Assist

Association of thrombophilia prospective detection with hemocompatibility related outcomes in left ventricular assist device patients

2021 ◽  
pp. 039139882110416
Author(s):  
Miroslav Konarik ◽  
Ivan Netuka ◽  
Peter Ivak ◽  
Hynek Riha ◽  
Zuzana Tucanova ◽  
...  
Keyword(s):  
Risk Factor ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Factor Ii ◽  
Pump Thrombosis ◽  
Left Ventricular Assist ◽  
Thrombotic Complications

Introduction: Inherited thrombophilias represent a concerning risk factor due to a proclivity to an aberrant clot formation. However, in patients with left ventricular assist device (LVAD), their impact on bleeding and thrombotic complications remains still poorly understood. The aim of the present study was to evaluate the effect of thrombophilic mutation directed anticoagulation therapy on adverse clinical outcomes in LVAD patients. Materials and methods: About 138 consecutive patients indicated for LVAD implant (HeartMate II, Abbott, Plymouth, USA) were prospectively screened for three major thrombophilic mutations: factor II (prothrombin), factor V Leiden, and homozygous methylenetetrahydrofolate reductase (MTHFR). Subsequently, discordant individualized anticoagulation targets of INR 2.5–3.0 in thrombophilia positive and INR 1.8–2.2 in negative patients were established; notably without anti-platelet agents given the center standard of care. Results: Mean age was 50 ± 12.7 years, 83% male. Mean duration of support was 464.5 days (SD 482.9; SEM 41.1) and median of 310 days (IQR 162; 546). Full thrombophilia positive cohort analysis has not revealed any significant impact on event free survival. In contrast, detailed analysis of specific thrombophilias subsets has revealed Factor II prothrombin mutation as a significant predisposition for the pump thrombosis risk (SHR 10.48; p = 0.001) despite more aggressive prespecified anticoagulation target. Moreover, the incidence of bleeding events in prothrombin group was also significantly increased (SHR 6.0; p = 0.03). Conclusions: Our observations suggest that specific thrombophilias in LVAD patients may pose different intensity predisposition for thrombotic complications. Factor II (prothrombin) positive mutation was identified as significant risk factor associated with the pump thrombosis.

Risk factor analysis of Swedish Left Ventricular Assist Device (LVAD) patients

2003 ◽  
Vol 76 (6) ◽  
pp. 1993-1998 ◽  
Author(s):  
Hans Granfeldt ◽  
Bansi Koul ◽  
Lars Wiklund ◽  
Bengt Peterzén ◽  
Urban Lönn ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Risk Factor ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Risk Factor Analysis ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Abstract 19105: Basis for Biochemical Discordance Between Activated Partial Thromboplastin Time and Anti-factor Xa in Patients with Continuous Flow Left Ventricular Assist Device on Unfractionated Heparin Infusion

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hirad Yarmohammadi ◽  
Amy J Feng ◽  
Chadi M Alraies ◽  
Thenappan Thenappan ◽  
Monica Colvin ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Continuous Flow ◽  
Factor Xa ◽  
Left Ventricular ◽  
Activated Partial Thromboplastin Time ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Introduction: Unfractionated Heparin (UFH) has been the mainstay of therapy for bridging and treatment of suspected device thrombosis/hemolysis in Continuous Flow Left Ventricular Assist Device (CF-LVAD), however the optimal monitoring test has not been prospectively evaluated. We previously reported that that Activated Partial Thromboplastin Time (aPTT) and anti-Xa levels measured simultaneously are frequently discordant in these patients. Hypothesis: Warfarin administration and hemolysis might be the biochemical basis for discordance between aPTT and anti-Xa in patients with CF-LVAD requiring UFH. Methods: A prospective observational study consisting of 38 patients with HeartMateII, consecutively admitted for UFH therapy with simultaneous measurements of aPTT and anti-factor Xa levels. Patients were stratified based on requirement of UFH for either sub-therapeutic INR or suspected device thrombosis. Patients were grouped according to whether the paired values fell within or outside the concordant therapeutic range, when discordant thromboelastography and factor analysis were performed. Results: Anti-Xa and aPTT were concordant 41.9% of the time in those getting treated for sub-therapeutic INR and only 18.8% in the group that getting treated for hemolysis/ device thrombosis. Data pairs with a supratherapeutic aPTT values were most likely to be associated with an INR ≥1.5, (p<0.001) (figure). On logistic regression analysis, high LDH was found to be a significant predictor of discordance (95% CI: 1.47-3.84). There was no consistent relationship between thromboelastography and factor analysis in the incidence of discordance. Conclusions: The relationship between aPTT and anti-factor Xa is not consistent in patients with CF-LVAD and the most common pattern was a supra-therapeutic aPTT relative to anti-factor Xa . Elevated LDH which is the sign for hemolysis and warfarin administration might contribute to an increased incidence of discordance.

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