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Updated: Apr 14, 2026
In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Incidence and Risk Factor Analysis for Gastrointestinal Bleeding and Pump Thrombosis in Left Ventricular Assist
Alex C Lopilato1, Christina Teeter Doligalski1, Christiano Caldeira2
1Department of Pharmacy, Tampa General Hospital, Tampa, FL, USA.
Insights
Left ventricular assist devices (LVADs) can cause bleeding and pump thrombosis. Post-implant factors like infection and pump speed increase risks, while few pre-implant factors are identified for gastrointestinal bleeding (GIB) and pump thrombosis (PT).
Area of Science:
- Cardiology
- Biomedical Engineering
- Hematology
Background:
- Left ventricular assist devices (LVADs) are crucial for end-stage heart failure but are linked to hemostatic complications.
- Gastrointestinal bleeding (GIB) and pump thrombosis (PT) are significant morbidities following LVAD implantation.
- Optimizing patient selection and management requires understanding the incidence and risk factors for these complications.
Purpose of the Study:
- To determine the incidence of GIB and PT in patients receiving continuous-flow LVADs.
- To identify pre-implantation and post-implantation risk factors associated with GIB and PT.
- To provide insights for improving patient selection and management strategies for LVAD recipients.
Main Methods:
- Retrospective review of 64 patients who underwent first LVAD implantation between October 2011 and September 2013.
- Analysis of epidemiological data and risk factors for GIB and PT.
- Statistical methods included descriptive statistics, chi-squared tests, and t-tests; ROC analysis for LDH.
Main Results:
- The 12-month incidence of GIB was 23.4% and PT was 12.5%.
- Post-implantation risk factors for PT included female sex and lack of antiplatelet therapy. Elevated lactate dehydrogenase (LDH >500) was a significant predictor.
- Post-implantation risk factors for GIB included infection and elevated plasma-free hemoglobin (pfHg). Increased pump speed was also confirmed as a risk factor.
Conclusions:
- LVAD implantation is associated with early hemostatic-related morbidity, including GIB and PT.
- Few pre-implantation risk factors were identified, highlighting the importance of post-implantation monitoring and management.
- Post-implantation factors such as infection, pump speed, and antiplatelet therapy require careful consideration to mitigate risks.
Abstract:
Left ventricular assist devices (LVADs) are associated with hemostatic complications. We describe the incidence and risk factors for gastrointestinal bleeding (GIB) and pump thrombosis (PT) to optimize patient selection/management. An IRB-approved retrospective review of first LVAD implants between October 1, 2011 and September 30, 2013 at a single center was conducted. Endpoints included epidemiological and risk factor analyses for GIB and PT. Descriptive statistics, chi-squared, and t-tests were used. Sixty-four patients received continuous-flow LVADs. The 12-month incidence of GIB and PT was 23.4% and 12.5%. Time to first GIB was 72.6 days (9-160). The 1-, 3-, and 6-month rate of PT was 1.6%, 6.25%, and 12.5%, respectively. All PT required pump exchange. Females (50% vs. 16%, P = 0.026) and patients without antiplatelet therapy (12.5% vs. 50%, P = 0.046) were at increased risk of PT. No pre-implant comorbidities were associated with PT. Infection was not identified as a risk factor in our cohort (25% vs. 51.8%, P = 0.156). Mean INR preceding event was not different from nonevent patients (2.1 vs. 2.24, P = 0.24). Regarding biomarkers preceding event, elevated plasma free hemoglobin (pfHg) did not reach significance (75% vs. 58%, P = 0.383) while lactate dehydrogenase was elevated significantly (744 vs. 298, P < 0.001). Receiver operating characteristic (ROC) analysis demonstrated that an LDH of >500 was highly sensitive and specific for PT. No pre-implant factors were associated with GIB. Post-implant risk factors for GIB included infection (80% vs. 38.8%, P = 0.005) and infrequent elevations in pfHg (13.3% vs. 63.3%, P < 0.001). Increased pump speed as a GIB risk factor was confirmed (HeartMate II 9560 rpm vs. 9490 rpm, P < 0.001; HeartWare 2949 rpm vs. 2710 rpm, P < 0.001). Anticoagulation/antiplatelet therapy did not affect GIB: mean INR preceding event was not different from nonevent patients (2.21 vs. 2.27, P = 0.67) and antiplatelet use was not different (46.7% vs. 46.9%, P = 0.985). LVADs are associated with early hemostatic-related morbidity. Few pre-implantation risk factors were elucidated; however, post-implantation factors including antiplatelet therapy, infection, and pump speed were identified.
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