Prior hematologic conditions carry a high morbidity and mortality in patients supported with continuous-flow left ventricular assist devices

Justin Fried, Allison P. Levin, Kanika M. Mody, Arthur R. Garan, Melana Yuzefpolsakaya, Hiroo Takayama, David L. Diuguid, Yoshifumi Naka, Ulrich P. Jorde, Nir Uriel

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Mechanical support leads to an increased risk of both bleeding and thrombotic events, but little is known about the risk of device support in patients with a baseline predisposition to these events. The aim of this study was to examine outcomes among patients with baseline hematologic conditions who underwent continuous-flow LVAD implantation (CF-LVAD).

Methods: We retrospectively reviewed records of 286 patients who underwent CF-LVAD implantation at the Columbia University Medical Center between April 2008 and December 2013. Patients diagnosed with the following hematologic conditions were enrolled: idiopathic thrombocytopenic purpura (ITP); Factor V Leiden; elevated Factor VIII; heparin-induced thrombocytopenia (HIT); or undefined hypercoagulable state.

Results: Of the 286 CF-LVAD patients implanted during the study period, 12 were considered to have a significant hematologic condition predisposing them to either bleeding or thrombotic events. The study included 5 patients with ITP, 1 with Factor V Leiden, 1 with elevated Factor VIII, 2 with HIT and 3 patients with undefined hypercoagulable state. Patients were supported for a total of 168.46 months, with a median of 10.76 months (IQR 4.78 to 21.36 months). There was a high frequency of thrombotic (0.57 event per patient-year), neurologic (0.36 event per patient-year) and bleeding (0.64 event per patient-year). Actuarial survival rates at 6 and 12 months were 81.8%, but fell to 49% at 2 years.

Conclusions: Patients with a history of prior hematologic conditions are at high risk for bleeding, thrombotic and neurologic events during device support, leading to early mortality. This case series questions the benefit of CF-LVAD in these patients and the appropriate management with regard to anti- coagulation. Further studies on the outcomes of these patients are warranted.

Original languageEnglish (US)
Pages (from-to)1119-1125
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume33
Issue number11
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

Heart-Assist Devices
Morbidity
Mortality
Hemorrhage
Idiopathic Thrombocytopenic Purpura
Factor VIII
Nervous System
Heparin
Equipment and Supplies
Thrombocytopenia

Keywords

  • bleeding
  • hematological conditions
  • hypercoagulable
  • ITP
  • LVAD
  • mechanical circulatory support
  • patient selection
  • thrombosis

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Prior hematologic conditions carry a high morbidity and mortality in patients supported with continuous-flow left ventricular assist devices. / Fried, Justin; Levin, Allison P.; Mody, Kanika M.; Garan, Arthur R.; Yuzefpolsakaya, Melana; Takayama, Hiroo; Diuguid, David L.; Naka, Yoshifumi; Jorde, Ulrich P.; Uriel, Nir.

In: Journal of Heart and Lung Transplantation, Vol. 33, No. 11, 01.11.2014, p. 1119-1125.

Research output: Contribution to journalArticle

Fried, Justin ; Levin, Allison P. ; Mody, Kanika M. ; Garan, Arthur R. ; Yuzefpolsakaya, Melana ; Takayama, Hiroo ; Diuguid, David L. ; Naka, Yoshifumi ; Jorde, Ulrich P. ; Uriel, Nir. / Prior hematologic conditions carry a high morbidity and mortality in patients supported with continuous-flow left ventricular assist devices. In: Journal of Heart and Lung Transplantation. 2014 ; Vol. 33, No. 11. pp. 1119-1125.
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abstract = "Background: Mechanical support leads to an increased risk of both bleeding and thrombotic events, but little is known about the risk of device support in patients with a baseline predisposition to these events. The aim of this study was to examine outcomes among patients with baseline hematologic conditions who underwent continuous-flow LVAD implantation (CF-LVAD).Methods: We retrospectively reviewed records of 286 patients who underwent CF-LVAD implantation at the Columbia University Medical Center between April 2008 and December 2013. Patients diagnosed with the following hematologic conditions were enrolled: idiopathic thrombocytopenic purpura (ITP); Factor V Leiden; elevated Factor VIII; heparin-induced thrombocytopenia (HIT); or undefined hypercoagulable state.Results: Of the 286 CF-LVAD patients implanted during the study period, 12 were considered to have a significant hematologic condition predisposing them to either bleeding or thrombotic events. The study included 5 patients with ITP, 1 with Factor V Leiden, 1 with elevated Factor VIII, 2 with HIT and 3 patients with undefined hypercoagulable state. Patients were supported for a total of 168.46 months, with a median of 10.76 months (IQR 4.78 to 21.36 months). There was a high frequency of thrombotic (0.57 event per patient-year), neurologic (0.36 event per patient-year) and bleeding (0.64 event per patient-year). Actuarial survival rates at 6 and 12 months were 81.8{\%}, but fell to 49{\%} at 2 years.Conclusions: Patients with a history of prior hematologic conditions are at high risk for bleeding, thrombotic and neurologic events during device support, leading to early mortality. This case series questions the benefit of CF-LVAD in these patients and the appropriate management with regard to anti- coagulation. Further studies on the outcomes of these patients are warranted.",
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AU - Levin, Allison P.

AU - Mody, Kanika M.

AU - Garan, Arthur R.

AU - Yuzefpolsakaya, Melana

AU - Takayama, Hiroo

AU - Diuguid, David L.

AU - Naka, Yoshifumi

AU - Jorde, Ulrich P.

AU - Uriel, Nir

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KW - hematological conditions

KW - hypercoagulable

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KW - LVAD

KW - mechanical circulatory support

KW - patient selection

KW - thrombosis

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