Bleeding and Thrombosis in Patients With Continuous-Flow Ventricular Assist Devices

Eckman, Peter; John, Ranjit

doi:10.1161/circulationaha.111.040246

Cited by 279 publications

(221 citation statements)

References 105 publications

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“…[477][478][479] Recently, mechanical LV assist devices (LVADs) have been implanted with increasing frequency in patients with advanced heart failure caused by severe LV systolic dysfunction as a bridge to transplantation, bridge to recovery, or destination therapy. Current-generation LVADs are associated with nonhemorrhagic cerebrovascular infarction rates of 4% to 9% per year, 480 and the risk is 2-to 3-fold higher in patients with prior stroke or postoperative infections. 481 Routine anticoagulation with VKA therapy and antiplatelet agents is recommended after LVAD implantation.…”

mentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Kernan¹,

Ovbiagele²,

Black³

et al. 2014

Stroke

3,990

1,326

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The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

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mentioning

confidence: 99%

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Kernan¹,

Ovbiagele²,

Black³

et al. 2014

Stroke

3,990

1,326

View full text Add to dashboard Cite

show abstract

“…Case reports have suggested improvement in hemostasis with infusion of von Willebrand factor concentrate, but thrombotic events have also been reported. 47 In adults with refractory gastrointestinal hemorrhage, case series have suggested a benefit with octreotide or thalidomide therapy. 47 Lastly, hemorrhage refractory to medical management is an indication for urgent heart transplantation and upgrading to United Network for Organ Sharing status 1A should be considered.…”

Section: Management Of Hemorrhagic Complicationsmentioning

confidence: 99%

Mechanical circulatory support: balancing bleeding and clotting in high-risk patients

Kreuziger

Massicotte

2015

Hematology

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Mechanical circulatory support (MCS) provides a bridge to heart transplant in children and adults with life-threatening heart failure and sustains patients ineligible for transplant. Extracorporeal membrane oxygenation (ECMO) provides temporary support for patients in cardiac or pulmonary failure through external gas exchange and continuous flow of blood. Because the median time to heart transplant exceeds event-free time on ECMO, pulsatile left ventricular assist devices (LVADs) are used to support infants and children. Continuous flow LVADs are preferred in adolescents and adults due to increased pump durability and improved overall survival. The shear stress created by the mechanical pumps cause changes in the hematologic system; acquired von Willebrand syndrome occurs in almost all patients treated with MCS. Despite the improvements in survival, major bleeding occurs in one-third of patients with a LVAD and ischemic stroke and LVAD thrombosis can affect 12% of adults and 29% of children. An antithrombotic strategy to mitigate LVAD bleeding and thrombotic complications has been tested in a randomized trial in children, but intensity of antithrombotic therapy in adults varies widely. Consensus guidelines for antithrombotic therapy during ECMO were created due to significant differences in management across centers. Because of the high risk for both bleeding and thrombotic complications, experts in hemostasis can significantly impact care of patients requiring mechanical circulatory support and are a necessary part of the management team. Learning Objectives• Understand available options for mechanical circulatory support and the impact of mechanical circulatory support on the hematologic system • Differentiate the bleeding and thrombotic risks between children and adults requiring mechanical circulatory support • Recognize possible treatment options for mechanical circulatory support thrombosis Heart failure affects Ͼ5 million adults in the United States (US) and 23 million people globally. 1 The incidence of heart failure in children is significantly less than adults with ϳ18 admissions per 100 000 children per year; however, there is significant economic impact of pediatric heart failure given the frequent need for surgical intervention and the loss of productive years in the event of a child's death. 2 The heart failure etiology also differs with age as most children have congenital heart disease and adults experience cardiomyopathy or coronary artery disease. 1

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“…Octreotide is also used in patients with LVADs, although its efficacy has not been firmly established. In one study the use of octreotide did not affect red cell transfusion number or rebleeding rates, suggesting that it has little or no impact on outcomes [30]. The use of thalidomide has been suggested based on some success in patients with HHT [31,32], however, the associated thrombotic risk of the drug is concerning for use in patients with LVADs and is not recommended at this time.…”

Section: Mild To Moderate Bleedingmentioning

confidence: 99%

Anticoagulation management of left ventricular assist devices

Connors

2014

American J Hematol

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Bleeding and Thrombosis in Patients With Continuous-Flow Ventricular Assist Devices

Cited by 279 publications

References 105 publications

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

Mechanical circulatory support: balancing bleeding and clotting in high-risk patients

Anticoagulation management of left ventricular assist devices

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