Early signatures of bleeding and mortality in patients on left ventricular assist device support: novel methods for personalized risk-stratification

Shrout, Tara; Sexton, Travis; Vsevolozhskaya, Olga A.; Guglin, Maya; Shafii, Alexis E.; Smyth, Susan S.

doi:10.1080/1354750x.2019.1609089

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…Paradoxically, however, they also displayed lower PFA-100 closure times, consistent with increased platelet activation. Similar findings were observed by Shrout et al 18 who found that early platelet activation and later increased ristocetin-induced platelet aggregation were common in patients who developed GIB. Platelet activation in these patients may be in response to ongoing bleeding.…”

Section: Discussionsupporting

confidence: 89%

Comparison of two individualized antithrombotic protocols in HeartWare HVAD recipients

et al. 2021

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We previously reported low rates of pump thrombosis and hemorrhagic stroke, but increased bleeding, under our original antithrombosis protocol (P1) in HeartWare recipients. We designed and implemented a revised protocol (P2) to reduce complexity and bleeding. Thrombelastography and PFA-100 guide antiplatelet titration.Goals for P2 were altered to decrease antiplatelet use and anticoagulation intensity. We compared the incidence and rates of gastrointestinal bleeding (GIB), embolic (eCVA) and hemorrhagic (hCVA) stroke, pump thrombosis (PT), and total bleeding (GIB+hCVA), total thrombosis (eCVA+PT), and total events between P1 and P2. Laboratory and medication data were assessed. Patients with and without hemocompatibility-related adverse events (HRAEs) were compared. The study in-

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Section: Discussionsupporting

confidence: 89%

Comparison of two individualized antithrombotic protocols in HeartWare HVAD recipients

et al. 2021

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“…Over 3 years, Shore et al 22 found a 4% increase in mortality for every pRBC unit transfused perioperatively (HR 1.04; 95% CI 1.02–1.07). Contrary to these findings, a small retrospective study by Shrout et al 23 observed no association between post-operative transfusion use and one-year outcomes. However, this study of 61 patients used much fewer blood products in the week following implantation.…”

Section: Discussionmentioning

confidence: 99%

Bleeding and thrombotic complications and their impact on mortality in patients supported with left ventricular assist device for cardiogenic shock

et al. 2022

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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.

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“…Her group published an impressive 175 papers and countless abstracts while at UK, focusing on the roles of lysolipids and autotaxin in platelet activation and the effects of thromboinflammation in sepsis and left ventricular assist device surgery. [19][20][21][22][23][24] She mentored 12 junior faculty and 39 trainees. Along with being an outstanding and caring physician, she still made time to lecture in and direct several courses.…”

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confidence: 99%

Susan S. Smyth (1965–2022)

Parise

Coller

Whiteheart

et al. 2023

ATVB

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PhD, who passed away on December 31, 2022 at the age of 57 years. Susan most recently served as Executive Vice Chancellor and Dean of the College of Medicine at the University of Arkansas for Medical Sciences (UAMS). Susan was a renowned cardiologist, clinical scientist, and academic leader. She leaves behind her husband, Andrew Morris, PhD, professor in the Department of Pharmacology and Toxicology at UAMS, their two sons Edward and William, along with many colleagues and trainees who are still coming to terms with this tragic loss.Susan grew up in Chapel Hill, NC, the daughter of University of North Carolina (UNC) philosophy professor Richard Smyth and Luan Smyth, in a 150-year-old homestead in the beautiful countryside of Chapel Hill. She attended Mount Holyoke College where she graduated summa cum laude in 1987. Later that year, she joined the MD/PhD program at UNC. This was before the university had the robust, well-funded program that would evolve a few years later. At that time, Susan had to apply separately to medical and graduate school, be accepted by both, and coordinate between the two entities, an experience that would help shape her later passion to facilitate and enhance MD/PhD training.In 1990, Susan joined the laboratory of a new Assistant Professor in the Department of Pharmacology, Leslie Parise, PhD, as one of her first two graduate students. For

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Early signatures of bleeding and mortality in patients on left ventricular assist device support: novel methods for personalized risk-stratification

Cited by 3 publications

References 32 publications

Comparison of two individualized antithrombotic protocols in HeartWare HVAD recipients

Comparison of two individualized antithrombotic protocols in HeartWare HVAD recipients

Bleeding and thrombotic complications and their impact on mortality in patients supported with left ventricular assist device for cardiogenic shock

Susan S. Smyth (1965–2022)

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