Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices

Jorge Suarez, Chetan B. Patel, G. Michael Felker, Richard Becker, Adrian F. Hernandez, Joseph G. Rogers

Research output: Contribution to journalArticle

174 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)779-784
Number of pages6
JournalCirculation: Heart Failure
Volume4
Issue number6
DOIs
StatePublished - Nov 1 2011
Externally publishedYes

Keywords

  • Bleeding rates
  • Gastrointestinal bleeding
  • Left ventricular assist devices
  • Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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