Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients
Abstract Aims Left ventricular assist devices (LVADs) have reduced the mortality of patients with advanced heart failure both as bridge‐to‐transplant and as destination therapy. However, LVADs are associated with various complications, including bleedings, which affect the prognosis. The aim of the...
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13899 |
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| author | Laetitia Pourtau Maxime Beneyto Jean Porterie Jerome Roncalli Montse Massot Caroline Biendel Pauline Fournier Romain Itier Michel Galinier Olivier Lairez Clement Delmas |
| author_facet | Laetitia Pourtau Maxime Beneyto Jean Porterie Jerome Roncalli Montse Massot Caroline Biendel Pauline Fournier Romain Itier Michel Galinier Olivier Lairez Clement Delmas |
| author_sort | Laetitia Pourtau |
| collection | DOAJ |
| description | Abstract Aims Left ventricular assist devices (LVADs) have reduced the mortality of patients with advanced heart failure both as bridge‐to‐transplant and as destination therapy. However, LVADs are associated with various complications, including bleedings, which affect the prognosis. The aim of the study was to explore the prevalence, management, and outcomes of haemorrhagic adverse events in LVAD recipients. Methods and results We conducted a retrospective, single‐centre, cohort study including all patients who received an LVAD from January 2008 to December 2019 in our tertiary centre (Rangueil University Hospital, Toulouse, France). Bleeding events, death, and heart transplantation were collected from electronic medical files. Eighty‐eight patients were included, and 43 (49%) presented at least one bleeding event. Gastrointestinal (GI) bleeding was the most frequent (n = 21, 24%), followed by epistaxis (n = 12, 14%) and intracranial haemorrhage (n = 9, 10%). Bleeding events were associated with increased mortality [hazard ratio (HR) 3.8, 95% confidence interval (CI) 1.5–9.3, P < 0.01], particularly in case of intracranial haemorrhage (HR 14.6, 95% CI 4.2–51.1, P < 0.0001). GI bleedings were associated with a trend towards increased mortality (HR 3.0, 95% CI 0.9–9.3, P = 0.05). Each bleeding episode multiplied the risk of death by 1.8 (95% CI 1.2–2.7, P < 0.01). Finally, only early bleedings (<9 months post‐implantation) had an impact on mortality (HR 4.2, 95% CI 1.6–11.1, P < 0.01). Therapeutic management was mainly based on temporary interruption of anticoagulation and permanent interruption of antiplatelet therapy. Invasive management was rarely performed. Conclusions Haemorrhagic events in LVAD recipients are frequent and associated with increased mortality. GI bleedings are the most frequent, and intracranial haemorrhages the most associated with mortality. Management remains empirical requiring more research. |
| format | Article |
| id | doaj-art-0524d618e0214bb9ae5750ecff93e927 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
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| series | ESC Heart Failure |
| spelling | doaj-art-0524d618e0214bb9ae5750ecff93e9272025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931931194110.1002/ehf2.13899Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipientsLaetitia Pourtau0Maxime Beneyto1Jean Porterie2Jerome Roncalli3Montse Massot4Caroline Biendel5Pauline Fournier6Romain Itier7Michel Galinier8Olivier Lairez9Clement Delmas10Department of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiovascular Surgery Rangueil University Hospital Toulouse FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceDepartment of Cardiology Rangueil University Hospital 1 avenue Jean Poulhès, TSA 50032 Toulouse 31059 FranceAbstract Aims Left ventricular assist devices (LVADs) have reduced the mortality of patients with advanced heart failure both as bridge‐to‐transplant and as destination therapy. However, LVADs are associated with various complications, including bleedings, which affect the prognosis. The aim of the study was to explore the prevalence, management, and outcomes of haemorrhagic adverse events in LVAD recipients. Methods and results We conducted a retrospective, single‐centre, cohort study including all patients who received an LVAD from January 2008 to December 2019 in our tertiary centre (Rangueil University Hospital, Toulouse, France). Bleeding events, death, and heart transplantation were collected from electronic medical files. Eighty‐eight patients were included, and 43 (49%) presented at least one bleeding event. Gastrointestinal (GI) bleeding was the most frequent (n = 21, 24%), followed by epistaxis (n = 12, 14%) and intracranial haemorrhage (n = 9, 10%). Bleeding events were associated with increased mortality [hazard ratio (HR) 3.8, 95% confidence interval (CI) 1.5–9.3, P < 0.01], particularly in case of intracranial haemorrhage (HR 14.6, 95% CI 4.2–51.1, P < 0.0001). GI bleedings were associated with a trend towards increased mortality (HR 3.0, 95% CI 0.9–9.3, P = 0.05). Each bleeding episode multiplied the risk of death by 1.8 (95% CI 1.2–2.7, P < 0.01). Finally, only early bleedings (<9 months post‐implantation) had an impact on mortality (HR 4.2, 95% CI 1.6–11.1, P < 0.01). Therapeutic management was mainly based on temporary interruption of anticoagulation and permanent interruption of antiplatelet therapy. Invasive management was rarely performed. Conclusions Haemorrhagic events in LVAD recipients are frequent and associated with increased mortality. GI bleedings are the most frequent, and intracranial haemorrhages the most associated with mortality. Management remains empirical requiring more research.https://doi.org/10.1002/ehf2.13899Left ventricular assist deviceBleedingHeart failureMortality |
| spellingShingle | Laetitia Pourtau Maxime Beneyto Jean Porterie Jerome Roncalli Montse Massot Caroline Biendel Pauline Fournier Romain Itier Michel Galinier Olivier Lairez Clement Delmas Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients ESC Heart Failure Left ventricular assist device Bleeding Heart failure Mortality |
| title | Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients |
| title_full | Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients |
| title_fullStr | Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients |
| title_full_unstemmed | Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients |
| title_short | Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients |
| title_sort | prevalence management and outcomes of haemorrhagic events in left ventricular assist device recipients |
| topic | Left ventricular assist device Bleeding Heart failure Mortality |
| url | https://doi.org/10.1002/ehf2.13899 |
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