Predicting Bleeding and Thrombosis Complications in Patients with Continuous Flow Left Ventricular Assist Devices

Authors

Kyle Zacholski, University of Kentucky
William Kuan, University of Kentucky
Justin McCann McCann, University of Kentucky
Aric Schadler, University of Kentucky
Aaron Cook, University of Kentucky
Sara Parli, University of Kentucky
Adam Sieg, University of KentuckyFollow

Document Type

Original Research

Abstract

Background: Left ventricular assist device (LVAD) therapy has been proven to relieve heart failure symptoms and improve survival, but is not devoid of bleeding and/or thrombotic complications. Risk stratification tools have been utilized in other cardiovascular disease populations to estimate the risk of bleeding and thrombosis with and without anticoagulation, including the HAS-BLED, HEMORR₂HAGES, CHADS₂ and CHA₂DS₂-VASc models. The study objective was to evaluate the predictive value of available risk models for bleeding and thrombotic complications in patients with an LVAD within one year of implantation.

Methods: This was a retrospective, single-center analysis of patients implanted with the HeartMate II continuous-flow LVAD from July 2011 to June 2016. All patients who received an LVAD within the study period were eligible for inclusion. The primary endpoint was the first occurrence of bleeding or thrombosis within one year from implantation. Baseline risk model scores were calculated at the time of LVAD implantation. Chi-square and student’s t-test were used to measure baseline differences and compare mean risk model scores between patients who had an event. A receiver operator characteristic (ROC) curve analysis was performed to evaluate the accuracy of the risk models to predict an event.

Results: A total of 129 patients underwent LVAD implantation within the study time period. Mean CHADS₂, CHA₂DS₂-VASc, and HAS-BLED scores were not significantly different in patients with and without an event. The mean HEMORR₂HAGES score was 3.09 and 2.51 in those with and without a bleeding event, respectively (p = 0.008). The ROC curve area for the HEMORR₂HAGES model was the highest at 0.620.

Conclusion: The HAS-BLED, HEMORR₂HAGES, CHADS₂and CHA2DS2-VASc risk stratification models did not accurately predict bleeding or thrombosis events in our population. The mean HEMORR₂HAGES model score was higher in patients who experienced a bleeding event. However, this model did not have strong positive predictive value. Better risk models are needed to predict bleeding and thrombotic events in this patient population.

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Recommended Citation

Zacholski, Kyle; Kuan, William; McCann, Justin McCann; Schadler, Aric; Cook, Aaron; Parli, Sara; and Sieg, Adam (2020) "Predicting Bleeding and Thrombosis Complications in Patients with Continuous Flow Left Ventricular Assist Devices," The VAD Journal: Vol. 6(1) :e2020612 DOI: https://doi.org/10.11589/vad/e2020612

Available at: https://digitalcommons.library.tmc.edu/vad/vol6/iss1/2

First Page

e2020612