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

11 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Alvarez, P., Cordero-Reyes, A. M., Uribe, C., De Hoyos, P., Martinez, D., Bhimaraj, A., Trachtenberg, B. H., Ashrith, G., Torre-Amione, G., Loebe, M., Amione-Guerra, J., Rice, L., & Estep, J. D. (Accepted/In press). 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