Coagulopathy in Mechanical Circulatory Support: A Fine Balance

Abstract

Therapeutic intervention with mechanical circulatory support has revolutionized the medical care of individuals living with advanced heart failure. Left ventricular assist devices (LVADs) have enabled patients to live longer while providing improved quality of life and functional status. However, intervention is not without risk. Over the last decade, clinicians have identified common mechanical assist device-associated complications. This appears to be multi-factorial with relation to patient variables, inherent device technology, and nuances of concurrent medical management. This review will discuss the impact of adverse hematologic complications: bleeding, pump thrombosis, and hemolysis in continuous flow LVAD patients. These obstacles continue to pose a clinical challenge with regard to both diagnosis and optimal management. Heightened awareness and understanding of heterogeneous clinical presentations is essential for preventive management and early detection with intervention.

Keywords: Bleeding; Coagulopathy; Heart failure; Left ventricular assist device; Management; Thrombosis.