Analysis of hemorrhagic and thromboembolic complications in patients with implanted left ventricular assist devices
Keywords:left ventricular assist device, anticoagulant targeted therapy, hemorrhagic and thromboembolic complications
AbstractThe work deals with the study of hemorrhagic and thromboembolic complications in the early postoperative period in patients with implanted left ventricular assist devices (LVAD). The study included 10 males aged 55.0 ± 13.5 years, with body mass index of 30.8 ± 8.3 kg/m2, left ventricular ejection fraction ranging from 9 to 28 %, who were implanted with LVAD under artificial blood circulation from 11.03.2016 to 22.11.2017 in the Silesian Center for Heart Disease (Poland). In the early postoperative period, patients received daily anticoagulant targeted therapy: heparin (6–11 U/kg/h), aspirin (75–150 mg), сlopidogrel (75–150 mg), warfarin (1.5–7 mg), nadroparin calcium (0.3–0.6 ml twice a day), fondaparinux sodium (2.5–5 mg twice a day). Two patients received heparin monotherapy, one patient — warfarin monotherapy for 14 days. Other patients during the same period received combined heparin therapy in the first three days with a subsequent transition to warfarin, aspirin, clopidogrel, fraxiparin, or thrombin blocker. The mechanical assistance of the left ventricle was carried out essentially by two different implantable systems performing one function of the left ventricular support: POLVAD — program-controlled pneumatic membrane mechanical blood circulation (2 patients), and LVAD — program-controlled electro-centrifugal circulation (8 persons). The duration of support by POLVAD system was from 102 to 156 days, by LVAD — from 20 to 78 days. A comparison of the analyzed results led to the conclusion that anticoagulant monotherapy with heparin or warfarin leads to an increase in the percentage of complications and mortality compared to the alternative combination anticoagulant targeted therapy: heparin (6–11 U/kg/h), aspirin (75–150 mg), clopidogrel (75–150 mg), warfarin (1.5–7 mg), nadroparin calcium (0.3–0.6 ml twice a day), fondaparinux sodium (2.5–5 mg twice a day), where survival rates were significantly higher, by 60 %
Kirklin J.K., Naftel D.C., Pagani F.D. et al. Seventh
INTERMACS annual report: 15,000 patients and counting // J. Heart Lung. Transplant. — 2015 Dec. — 34(12). — Р. 1495-504.
Akhter S.A., Badami A., Murray M. et al. Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost Analysis // Ann. Thorac. Surg. — 2015 Sep. — 100(3). — Р. 884-9.
Wever-Pinzon O., Drakos S.G, Kfoury A.G. et al. Morbidity and mortality in heart transplant candidates supported with mechanical circulatory support: is reappraisal of the current United network for organ sharing thoracic organ allocation policy justified // Circulation. — 2013, Jan 29. — 127(4). — Р. 452-62.
Mandeep R. Mehra, M.D.,Daniel J. et al. The MOMENTUM 3 Investigators “Two-Year Outcomes with Magnetically Levitated Cardiac Pump in Heart Failure” // New England Journal of Medicine in ELSERVIER base.
Klaus Görlinger, Lars Bergmann, Daniel Dirkmann. Coagulation management in patients undergoing mechanical circulatory support // Journal homepage ELSERVIER base: www.elsevier.com/locate/bean.
Amornsawadwattana S., Nassif M., Raymer D., LaRue S., Chen C.H. Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding // World J. Gastroenterol. — 2016, May 14. — 22(18). — Р. 4559-66.
Kushnir V.M., Sharma S., Ewald G.A. et al. Evaluation of GI bleeding after implantation of left ventricular assist device // Gastrointest. Endosc. — 2012 May. — 75(5). — Р. 973-9.
Crow S., Chen D., Milano C. et al. Acquired von Willebrand syndrome in continuous-flow ventricular assist device recipients // Ann. Thorac. Surg. — 2010. — 90(4). — Р. 1263-9.
Meyer A.L., Malehsa D., Bara C., et al. Acquired von Willebrand syndrome in patients with an axial flow left ventricular assist device // Circ. Heart Fail. — 2010. — 3(6). — Р. 675-81.
Slaughter M.S., Rogers J.G., Milano C.A. et al. HeartMate II Investigators. Advanced heart failure treated with continuous-flow left ventricular assist device // N. Engl. J. Med. — 2009, Dec 3. — 361(23). — Р. 2241-51.
Saeed O., Shah A., Kargoli F. et al. Antiplatelet Therapy and Adverse Hematologic Events During Heart Mate II Support // Circ. Heart Fail. — 2016 Jan. — 9(1). — e002296.
Bunte M.C., Blackstone E.H., Thuita L. et al. Major bleeding during HeartMate II support // J. Am. Coll. Cardiol. — 2013, Dec 10. — 62(23). — Р. 2188-96.
Wever-Pinzon O., Selzman C.H., Drakos S.G. et al. Pulsatility and the risk of nonsurgical bleeding in patients supported with the continuous-flow left ventricular assist device HeartMate II // Circ. Heart Fail. — 2013 May. — 6(3). — Р. 517-26.
Boyle A.J., Russell S.D., Teuteberg J.J. et al. Low thromboembolism and pump thrombosis with the HeartMate II left ventricular assist device: analysis of outpatient anti-coagulation // J. Heart Lung. Transplant. — 2009 Sep. — 28(9). — Р. 881-7.
Nassif M.E., LaRue S.J., Raymer D.S. et al. Relationship Between Anticoagulation Intensity and Thrombotic or Bleeding Outcomes Among Outpatients With Continuous-Flow Left Ventricular Assist Devices // Circ. Heart Fail. — 2016 May. — 9(5).
Harvey L., Holley C., Roy S.S et al. Stroke After Left Ventricular Assist Device Implantation: Outcomes in the Continuous-Flow Era // Ann. Thorac. Surg. — 2015. — 100(2). — Р. 535-41.
Morgan J.A., Brewer R.J., Nemeh H.W. et al. Stroke while on long-term left ventricular assist device support: incidence, outcome, and predictors // ASAIO J. — 2014 May-Jun. — 60(3). — Р. 284-9.
Xia Y., Stern D., Friedmann P., Goldstein D. Preoperative atrial fibrillation may not increase thromboembolic events in left ventricular assist device recipients on midterm follow-up // J. Heart Lung. Transplant. — 2016. — 35(7). — Р. 906-12.
Najjar S.S., Slaughter M.S., Pagani F.D. et al. HVAD Bridge to Transplant ADVANCE Trial Investigators. An analysis of pump thrombus events in patients in the HeartWare ADVANCE bridge to transplant and continued access protocol trial // J. Heart Lung. Transplant. — 2014 Jan. — 33(1). — Р. 23-34.
Uriel N., Morrison K.A., Garan A.R. et al. Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: the Columbia ramp study // J. Am. Coll. Cardiol. — 2012 Oct. — 30. — 60(18). — Р. 1764-75.
Maltais S., Kilic A., Nathan S. et al. Prevention of HeartMate II Pump Thrombosis Through Clinical Management (PREVENT) // J. Heart Lung. Transplant. — 2016. — 35(4). — Р. 161-162.
Starling R.C., Moazami N., Silvestry S.C. et al. Unexpected abrupt increase in left ventricular assist device thrombosis // N. Engl. J. Med. — 2014. — 370(1). — Р. 33-40.
Saeed D., Maxhera B., Albert A., Westenfeld R., Hoffmann T., Lichtenberg A. Conservative approaches for HeartWare ventricular assist device pump thrombosis may improve the outcome compared with immediate surgical approaches // Interact Cardiovasc. Thorac. Surg. — 2016. — 23(1). — Р. 90-5.
How to Cite
Copyright (c) 2019 O.P. Mazurenko, P. Nadzaykevich, O.A. Loskutov, L. Zgrezheblovskaya
This work is licensed under a Creative Commons Attribution 4.0 International License.