Does Gastrointestinal Bleeding Increase the Risk of Thromboembolic Events in Patients Supported With CF-LVADs?

Gastrointestinal bleeding is a common complication in continuous-flow left ventricular assist device (CF-LVAD) patients. Managing gastrointestinal bleeding often requires reducing or stopping anticoagulation, potentially increasing the risk of thromboembolic events. This study aimed to evaluate thromboembolic events in CF-LVAD recipients.

We analyzed data from our institutional Intermacs database from January 2008 to December 2023. The cohort included both primary implants and pump exchanges. Thromboembolic events were defined as ischemic stroke, transient ischemic attack, or pump thrombosis (excluding pre-gastrointestinal bleeding ones). Multivariable logistic regression was used to evaluate gastrointestinal bleeding as a risk factor for thromboembolic events.

Among 1075 CF-LVAD implants, the median age was 58.5 years (IQR 50.0-65.7), with 79.8% male. Most patients (80.6%) had an Intermacs profile ≤ 3. Gastrointestinal bleeding occurred in 32.2%, among whom thromboembolic events occurred in 26.3%. Median time from gastrointestinal bleeding to thromboembolic events was 12.7 months (IQR 4.0-24.5). Gastrointestinal bleeding increased the risk of thromboembolic events by 52% (OR 1.52, p = 0.018). Additionally, among all CF-LVAD implants, patients aged ≥ 50 years had a 66% higher risk (p = 0.024), and Black patients had twice the risk compared to non-Black patients (p < 0.001). Axial-flow (OR 3.9) and partial magnetically levitated centrifugal-flow LVADs (OR 3.5) were associated with significantly higher thromboembolic risk compared to fully magnetically levitated centrifugal-flow devices (p < 0.001).

Thromboembolic events remain a major risk in CF-LVAD patients. Gastrointestinal bleeding significantly increases thromboembolic risk. Higher risk was also seen in patients aged ≥ 50 years, Black patients, and those with older CF-LVAD models.