Related Experiment Video
Updated: Mar 27, 2026
In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices:
Paulino Alvarez1, Andrea M Cordero-Reyes1, Cesar Uribe1
1Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
Insights
Hypercoagulable states are common in patients with continuous flow left ventricular assist devices (CF-LVADs) and increase the risk of adverse events like deep vein thrombosis and hemorrhage.
Area of Science:
- Cardiology
- Hematology
- Medical Devices
Background:
- Thrombotic events are a major concern for patients with continuous flow left ventricular assist devices (CF-LVADs), leading to significant morbidity and mortality.
- Understanding the role of hypercoagulable states in these patients is crucial for improving outcomes.
Purpose of the Study:
- To determine the frequency of hypercoagulable states in patients undergoing CF-LVAD implantation.
- To characterize the clinical features and outcomes associated with hypercoagulable states in this population.
Main Methods:
- A retrospective review of 168 patients who received CF-LVADs between 2010 and 2013.
- Analysis of patient records for hereditary and acquired hypercoagulable states.
- Comparison of adverse outcomes (death, thrombosis, stroke, embolism) and event-free survival between groups.
Main Results:
- A hypercoagulable state was identified in 11.9% of patients (20/168), primarily acquired.
- Patients with hypercoagulable states showed a significantly higher incidence of deep vein thrombosis (15% vs 3%) and subarachnoid hemorrhage (15% vs 0%).
- Event-free survival was significantly lower in patients with hypercoagulable states (P=.005).
Conclusions:
- Hypercoagulable states are relatively common in CF-LVAD patients and are associated with increased morbidity.
- Further prospective research is necessary to fully elucidate the incidence, prevalence, and clinical significance of these states in patients considered for CF-LVAD.
Background:
Thrombotic events in patients with continuous flow left ventricular assist devices (CF-LVADs) are associated with significant morbidity and mortality. The objective of this study was to delineate the frequency, clinical characteristics, and outcomes of patients with hypercoagulable states who undergo CF-LVAD implantation.
Methods:
We performed a retrospective review of 168 consecutive patients who underwent CF-LVAD implantation between 2010 and 2013. Chart and laboratory data were reviewed for the presence of a hereditary and/or acquired hypercoagulable state. Adverse outcomes were defined as death, confirmed pump thrombosis, aortic root clot, stroke, deep vein thrombosis, and pulmonary embolism. Fisher's exact test and Kaplan-Meier estimate were used to analyze frequency of adverse outcomes and event free survival, respectively.
Results:
A hypercoagulable state was identified in 20 patients (11.9%). There were 18 patients with acquired, 1 with a congenital, and 1 with both congenital and acquired hypercoagulable states. The median follow-up was 429 days and 475 days in patients with and without hypercoagulable states, respectively. During the study period, 15% (3/20) of the patients with a hypercoagulable state had a diagnosis of deep vein thrombosis vs 3% (4/148) of the patients without a hypercoagulable state (P = .030). Only patients with a hypercoagulable state had a subarachnoid hemorrhage (3/20 vs 0/148; P < .01). The event-free survival was lower in the patients with hypercoagulable states (P = .005).
Conclusion:
Hypercoagulable states are not uncommon in patients with CF-LVADs and may be associated with increased morbidity. Prospective studies are needed to more accurately identify the incidence, prevalence, and significance of hypercoagulable states in patients being considered for CF-LVAD.
