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Case Reports
. 2019 Dec 6;2019(1):88-96.
doi: 10.1182/hematology.2019000067.

Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management

F W G Leebeek  1 , R Muslem  2
Affiliations
Case Reports

Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management

F W G Leebeek et al. Hematology Am Soc Hematol Educ Program. .

Abstract

Chronic heart failure (HF) is a growing health problem, and it is associated with high morbidity and mortality. Left ventricular assist devices (LVADs) are nowadays an important treatment option for patients with end-stage HF not only as a bridging tool to heart transplantation but also, as a permanent therapy for end-stage HF (destination therapy). The use of LVAD is associated with a high risk for bleeding complications and thromboembolic events, including pump thrombosis and ischemic stroke. Bleeding is the most frequent complication, occurring in 30% to 60% of patients, both early and late after LVAD implantation. Although the design of LVADs has improved over time, bleeding complications are still the most common complication and occur very frequently. The introduction of an LVAD results in an altered hemostatic balance as a consequence of blood-pump interactions, changes in hemodynamics, acquired coagulation abnormalities, and the strict need for long-term anticoagulant treatment with oral anticoagulants and antiplatelet therapy. LVAD patients may experience an acquired coagulopathy, including platelet dysfunction and impaired von Willebrand factor activity, resulting in acquired von Willebrand syndrome. In this educational manuscript, the epidemiology, etiology, and pathophysiology of bleeding in patients with LVAD will be discussed. Because hematologist are frequently consulted in cases of bleeding problems in these individuals in a critical care setting, the observed type of bleeding complications and management strategies to treat bleeding are also reviewed.

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Conflict of interest statement

Conflict-of-interest disclosure: F.W.G.L. received unrestricted research grants from CSL Behring and Shire/Takeda; is a consultant for CSL Behring, Shire/Takeda, and uniQure, of which the fees go to the university; and is a data safety monitoring board member of a study sponsored by Roche. All of these activities are outside the topic of this manuscript. R.M. declares no competing financial interests.

Figures

Figure 1.
Figure 1.
Hematological complications after LVAD implantation.
See this image and copyright information in PMC

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