Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices

Prevalence and Thrombotic Complications

Paulino Alvarez, Andrea M. Cordero-Reyes, Cesar Uribe, Patricio De Hoyos, Donna Martinez, Arvind Bhimaraj, Barry H. Trachtenberg, Guha Ashrith, Guillermo Torre-Amione, Matthias Loebe, Javier Amione-Guerra, Lawrence Rice, Jerry D. Estep

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Thrombotic events in patients with continuous flow left ventricular assist devices (CF-LVADs) are associated with significant morbidity and mortality. The objective of this study was to delineate the frequency, clinical characteristics, and outcomes of patients with hypercoagulable states who undergo CF-LVAD implantation. Methods: We performed a retrospective review of 168 consecutive patients who underwent CF-LVAD implantation between 2010 and 2013. Chart and laboratory data were reviewed for the presence of a hereditary and/or acquired hypercoagulable state. Adverse outcomes were defined as death, confirmed pump thrombosis, aortic root clot, stroke, deep vein thrombosis, and pulmonary embolism. Fisher's exact test and Kaplan-Meier estimate were used to analyze frequency of adverse outcomes and event free survival, respectively. Results: A hypercoagulable state was identified in 20 patients (11.9%). There were 18 patients with acquired, 1 with a congenital, and 1 with both congenital and acquired hypercoagulable states. The median follow-up was 429 days and 475 days in patients with and without hypercoagulable states, respectively. During the study period, 15% (3/20) of the patients with a hypercoagulable state had a diagnosis of deep vein thrombosis vs 3% (4/148) of the patients without a hypercoagulable state (P = .030). Only patients with a hypercoagulable state had a subarachnoid hemorrhage (3/20 vs 0/148; P <.01). The event-free survival was lower in the patients with hypercoagulable states (P = .005). Conclusion: Hypercoagulable states are not uncommon in patients with CF-LVADs and may be associated with increased morbidity. Prospective studies are needed to more accurately identify the incidence, prevalence, and significance of hypercoagulable states in patients being considered for CF-LVAD.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StateAccepted/In press - Apr 30 2015
Externally publishedYes

Fingerprint

Heart-Assist Devices
Venous Thrombosis
Disease-Free Survival
Morbidity
Kaplan-Meier Estimate
Subarachnoid Hemorrhage
Pulmonary Embolism
Thrombosis
Stroke

Keywords

  • HIT
  • Hypercoagulable states
  • Left ventricular assist device
  • Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices : Prevalence and Thrombotic Complications. / Alvarez, Paulino; Cordero-Reyes, Andrea M.; Uribe, Cesar; De Hoyos, Patricio; Martinez, Donna; Bhimaraj, Arvind; Trachtenberg, Barry H.; Ashrith, Guha; Torre-Amione, Guillermo; Loebe, Matthias; Amione-Guerra, Javier; Rice, Lawrence; Estep, Jerry D.

In: Journal of Cardiac Failure, 30.04.2015.

Research output: Contribution to journalArticle

Alvarez, P, Cordero-Reyes, AM, Uribe, C, De Hoyos, P, Martinez, D, Bhimaraj, A, Trachtenberg, BH, Ashrith, G, Torre-Amione, G, Loebe, M, Amione-Guerra, J, Rice, L & Estep, JD 2015, 'Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices: Prevalence and Thrombotic Complications', Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2015.12.020
Alvarez, Paulino ; Cordero-Reyes, Andrea M. ; Uribe, Cesar ; De Hoyos, Patricio ; Martinez, Donna ; Bhimaraj, Arvind ; Trachtenberg, Barry H. ; Ashrith, Guha ; Torre-Amione, Guillermo ; Loebe, Matthias ; Amione-Guerra, Javier ; Rice, Lawrence ; Estep, Jerry D. / Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices : Prevalence and Thrombotic Complications. In: Journal of Cardiac Failure. 2015.
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abstract = "Background: Thrombotic events in patients with continuous flow left ventricular assist devices (CF-LVADs) are associated with significant morbidity and mortality. The objective of this study was to delineate the frequency, clinical characteristics, and outcomes of patients with hypercoagulable states who undergo CF-LVAD implantation. Methods: We performed a retrospective review of 168 consecutive patients who underwent CF-LVAD implantation between 2010 and 2013. Chart and laboratory data were reviewed for the presence of a hereditary and/or acquired hypercoagulable state. Adverse outcomes were defined as death, confirmed pump thrombosis, aortic root clot, stroke, deep vein thrombosis, and pulmonary embolism. Fisher's exact test and Kaplan-Meier estimate were used to analyze frequency of adverse outcomes and event free survival, respectively. Results: A hypercoagulable state was identified in 20 patients (11.9{\%}). There were 18 patients with acquired, 1 with a congenital, and 1 with both congenital and acquired hypercoagulable states. The median follow-up was 429 days and 475 days in patients with and without hypercoagulable states, respectively. During the study period, 15{\%} (3/20) of the patients with a hypercoagulable state had a diagnosis of deep vein thrombosis vs 3{\%} (4/148) of the patients without a hypercoagulable state (P = .030). Only patients with a hypercoagulable state had a subarachnoid hemorrhage (3/20 vs 0/148; P <.01). The event-free survival was lower in the patients with hypercoagulable states (P = .005). Conclusion: Hypercoagulable states are not uncommon in patients with CF-LVADs and may be associated with increased morbidity. Prospective studies are needed to more accurately identify the incidence, prevalence, and significance of hypercoagulable states in patients being considered for CF-LVAD.",
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T1 - Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices

T2 - Prevalence and Thrombotic Complications

AU - Alvarez, Paulino

AU - Cordero-Reyes, Andrea M.

AU - Uribe, Cesar

AU - De Hoyos, Patricio

AU - Martinez, Donna

AU - Bhimaraj, Arvind

AU - Trachtenberg, Barry H.

AU - Ashrith, Guha

AU - Torre-Amione, Guillermo

AU - Loebe, Matthias

AU - Amione-Guerra, Javier

AU - Rice, Lawrence

AU - Estep, Jerry D.

PY - 2015/4/30

Y1 - 2015/4/30

N2 - Background: Thrombotic events in patients with continuous flow left ventricular assist devices (CF-LVADs) are associated with significant morbidity and mortality. The objective of this study was to delineate the frequency, clinical characteristics, and outcomes of patients with hypercoagulable states who undergo CF-LVAD implantation. Methods: We performed a retrospective review of 168 consecutive patients who underwent CF-LVAD implantation between 2010 and 2013. Chart and laboratory data were reviewed for the presence of a hereditary and/or acquired hypercoagulable state. Adverse outcomes were defined as death, confirmed pump thrombosis, aortic root clot, stroke, deep vein thrombosis, and pulmonary embolism. Fisher's exact test and Kaplan-Meier estimate were used to analyze frequency of adverse outcomes and event free survival, respectively. Results: A hypercoagulable state was identified in 20 patients (11.9%). There were 18 patients with acquired, 1 with a congenital, and 1 with both congenital and acquired hypercoagulable states. The median follow-up was 429 days and 475 days in patients with and without hypercoagulable states, respectively. During the study period, 15% (3/20) of the patients with a hypercoagulable state had a diagnosis of deep vein thrombosis vs 3% (4/148) of the patients without a hypercoagulable state (P = .030). Only patients with a hypercoagulable state had a subarachnoid hemorrhage (3/20 vs 0/148; P <.01). The event-free survival was lower in the patients with hypercoagulable states (P = .005). Conclusion: Hypercoagulable states are not uncommon in patients with CF-LVADs and may be associated with increased morbidity. Prospective studies are needed to more accurately identify the incidence, prevalence, and significance of hypercoagulable states in patients being considered for CF-LVAD.

AB - Background: Thrombotic events in patients with continuous flow left ventricular assist devices (CF-LVADs) are associated with significant morbidity and mortality. The objective of this study was to delineate the frequency, clinical characteristics, and outcomes of patients with hypercoagulable states who undergo CF-LVAD implantation. Methods: We performed a retrospective review of 168 consecutive patients who underwent CF-LVAD implantation between 2010 and 2013. Chart and laboratory data were reviewed for the presence of a hereditary and/or acquired hypercoagulable state. Adverse outcomes were defined as death, confirmed pump thrombosis, aortic root clot, stroke, deep vein thrombosis, and pulmonary embolism. Fisher's exact test and Kaplan-Meier estimate were used to analyze frequency of adverse outcomes and event free survival, respectively. Results: A hypercoagulable state was identified in 20 patients (11.9%). There were 18 patients with acquired, 1 with a congenital, and 1 with both congenital and acquired hypercoagulable states. The median follow-up was 429 days and 475 days in patients with and without hypercoagulable states, respectively. During the study period, 15% (3/20) of the patients with a hypercoagulable state had a diagnosis of deep vein thrombosis vs 3% (4/148) of the patients without a hypercoagulable state (P = .030). Only patients with a hypercoagulable state had a subarachnoid hemorrhage (3/20 vs 0/148; P <.01). The event-free survival was lower in the patients with hypercoagulable states (P = .005). Conclusion: Hypercoagulable states are not uncommon in patients with CF-LVADs and may be associated with increased morbidity. Prospective studies are needed to more accurately identify the incidence, prevalence, and significance of hypercoagulable states in patients being considered for CF-LVAD.

KW - HIT

KW - Hypercoagulable states

KW - Left ventricular assist device

KW - Thrombosis

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