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Prior hematologic conditions carry a high morbidity and mortality in patients supported with continuous-flow left ventricular assist devices.
[heparin-induced thrombocytopenia]
Mechanical
support
leads
to
an
increased
risk
of
both
bleeding
and
thrombotic
events
,
but
little
is
known
about
the
risk
of
device
support
in
patients
with
a
baseline
predisposition
to
these
events
.
The
aim
of
this
study
was
to
examine
outcomes
among
patients
with
baseline
hematologic
conditions
who
underwent
continuous-flow
LVAD
implantation
(
CF
-LVAD
)
.
We
retrospectively
reviewed
records
of
286
patients
who
underwent
CF
-LVAD
implantation
at
the
Columbia
University
Medical
Center
between
April
2008
and
December
2013
.
Patients
diagnosed
with
the
following
hematologic
conditions
were
enrolled
:
idiopathic
thrombocytopenic
purpura
(
ITP
)
;
Factor
V
Leiden
;
elevated
Factor
VIII
;
heparin-induced
thrombocytopenia
(
HIT
)
;
or
undefined
hypercoagulable
state
.
Of
the
286
CF
-LVAD
patients
implanted
during
the
study
period
,
12
were
considered
to
have
a
significant
hematologic
condition
predisposing
them
to
either
bleeding
or
thrombotic
events
.
The
study
included
5
patients
with
ITP
,
1
with
Factor
V
Leiden
,
1
with
elevated
Factor
VIII
,
2
with
HIT
and
3
patients
with
undefined
hypercoagulable
state
.
Patients
were
supported
for
a
total
of
168
.
46
months
,
with
a
median
of
10
.
76
months
(
IQR
4
.
78
to
21
.
36
months
)
.
There
was
a
high
frequency
of
thrombotic
(
0
.
57
event
per
patient-
year
)
,
neurologic
(
0
.
36
event
per
patient-
year
)
and
bleeding
(
0
.
64
event
per
patient-
year
)
.
Actuarial
survival
rates
at
6
and
12
months
were
81
.
8
%
,
but
fell
to
49
%
at
2
years
.
Patients
with
a
history
of
prior
hematologic
conditions
are
at
high
risk
for
bleeding
,
thrombotic
and
neurologic
events
during
device
support
,
leading
to
early
mortality
.
This
case
series
questions
the
benefit
of
CF
-LVAD
in
these
patients
and
the
appropriate
management
with
regard
to
anti-coagulation
.
Further
studies
on
the
outcomes
of
these
patients
are
warranted
.
Diseases
Validation
Diseases presenting
"but little is known about the risk of device support in patients with a baseline predisposition to these events"
symptom
heparin-induced thrombocytopenia
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