TY - JOUR
T1 - Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices
AU - Suarez, Jorge
AU - Patel, Chetan B.
AU - Felker, G. Michael
AU - Becker, Richard
AU - Hernandez, Adrian F.
AU - Rogers, Joseph G.
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2011/11
Y1 - 2011/11
N2 - Axial-flow LVADs have become an integral tool in the management of end-stage heart failure. Consequently, nonsurgical bleeding has emerged as a major source of morbidity and mortality in this fragile population. The mechanisms responsible for these adverse events include acquired von Willebrand disease, GI tract angiodysplasia formation, impaired platelet aggregation, and overuse of anticoagulation therapy. Because of ongoing concerns for pump thrombosis and thromboembolic events, the thrombotic/bleeding paradigm has led to a difficult clinical dilemma for those managing patients treated with axial flow LVADs. As the field progresses, advances in the understanding of the pathological mechanisms underlying bleeding/thrombosis risk, careful risk stratification, and potential use of novel anticoagulants will all play a role in the management of the LVAD patient.
AB - Axial-flow LVADs have become an integral tool in the management of end-stage heart failure. Consequently, nonsurgical bleeding has emerged as a major source of morbidity and mortality in this fragile population. The mechanisms responsible for these adverse events include acquired von Willebrand disease, GI tract angiodysplasia formation, impaired platelet aggregation, and overuse of anticoagulation therapy. Because of ongoing concerns for pump thrombosis and thromboembolic events, the thrombotic/bleeding paradigm has led to a difficult clinical dilemma for those managing patients treated with axial flow LVADs. As the field progresses, advances in the understanding of the pathological mechanisms underlying bleeding/thrombosis risk, careful risk stratification, and potential use of novel anticoagulants will all play a role in the management of the LVAD patient.
KW - Bleeding rates
KW - Gastrointestinal bleeding
KW - Left ventricular assist devices
KW - Thrombosis
UR - http://www.scopus.com/inward/record.url?scp=84855585557&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84855585557&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.111.962613
DO - 10.1161/CIRCHEARTFAILURE.111.962613
M3 - Article
C2 - 22086831
AN - SCOPUS:84855585557
SN - 1941-3289
VL - 4
SP - 779
EP - 784
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 6
ER -