Does infection predispose to thrombosis during long‐term ventricular assist device support?

Abstract

Background Infections and thrombotic events remain life‐threatening complications in patients with ventricular assist devices (VAD). Methods We describe the relationship between both events in our cohort of patients (n = 220) supported with the HeartWare VAD (HVAD). This is a retrospective analysis of patients undergoing HVAD implantation between July 2009 and March 2019 at the Freeman Hospital, Newcastle upon Tyne, United Kingdom. Results Infection was the most common adverse event in HVAD patients, with 125 patients (56.8%) experiencing ≥ one infection (n = 168, 0.33 event per person year (EPPY)), followed by pump thrombosis (PT) in 61 patients (27.7%, 0.16 EPPY). VAD‐specific infections were the largest group of infections. Of the 125 patients who had an infection, 66 (53%) had a thrombotic event. Both thrombotic events and infections were related to the duration of support, though there was only limited evidence that infections predispose to thrombosis. Those with higher than median levels of C‐reactive protein during the infection were more likely to have an ischaemic stroke (IS) (34.5% vs 16.7%, p = .03), though not PT or a combined thrombotic event (CTE: first PT or IS). However, in multivariate analysis, there was no significant effect of infection predisposing to CTE. Conclusions Infection and thrombotic events are significant adverse events related to the duration of support in patients receiving HVADs. Infections do not clearly predispose to thrombotic events.

Exercise oscillatory ventilation in patients with advanced heart failure with and without left ventricular assist device

“…We found a considerable mean readmission rate of 23.3% (only including Heartmate 3©), which goes along with findings of other studies 23,24 . It may be expected that readmission rates will decrease with the newer generation of LVADs, although driveline infections and pump thrombosis have recently been shown to remain a relevant factor for morbidity in newer generation devices 25,26 …”

“…23,24 It may be expected that readmission rates will decrease with the newer generation of LVADs, although driveline infections and pump thrombosis have recently been shown to remain a relevant factor for morbidity in newer generation devices. 25,26 In our study, average time since implantation was 17.9 months, which is a considerably longer period of time compared with the only available study on EOV in LVAD patients (mean 135 days). 27 vs. 27.0%), LVAD/EOV+ displayed more severely reduced LVEF (16.9% vs. 22.0%) and right ventricular function (TAPSE 10.3 mm vs. 13.0 mm) in our population.…”

Microembolic signal monitoring in patients with HeartMate 3 and HeartWare left ventricular assist devices: Association with antithrombotic treatment and cerebrovascular events

“…Besides a complete blood count, biochemical markers of inflammation and infection, hemolysis parameters (total serum bilirubin, free hemoglobin, and LDH), kidney and liver function, heart failure, and parameters of hemostasis (INR, partial thromboplastin time, D‐dimer) were measured. In addition, clinical and laboratory signs for infection were evaluated, since infection and inflammation are associated with thrombotic events 25 . Quantification of an acquired von Willebrand syndrome was not taken into account, as this is not a clinical standard in our center.…”

“…In addition, clinical and laboratory signs for infection were evaluated, since infection and inflammation are associated with thrombotic events. 25 Quantification of an acquired von Willebrand syndrome was not taken into account, as this is not a clinical standard in our center.…”

Infection calls for thrombosis: Fact or superstition?

“…When the patients were stratified as per presence of infection, PT (39.2% vs. 12.6%, p < 0.01) and combined thrombotic event (CTE) (52.8% vs. 22.1%, p < 0.01) were more prominent in those who experienced an episode of infection than in those who did not (Table 1 of Bouzas‐Cruz et al 9 ). Furthermore, in patients who experienced a CTE ( n = 87), infection was more frequent during follow‐up as compared to those who did not (75.9% vs. 44.4%, p < 0.01, Table 2 of Bouzas‐Cruz et al 9 ).…”