Bleeding
This is a common cause of morbidity and mortality in LVAD patients.
20-40% of patients will have a bleeding event requiring intervention.2
Bleeding is multifactorial, and due to:
- Anticoagulation
- Platelet dysfunction
- Lysis of Von Willibrand Factor
- RV dysfunction causing hepatic congestion and failure
- Vasoplegia
- Mucosal vascular dysplasia
Gastro-intestinal Bleeding – Key learning points:
- Small bleeds can turn very quickly into large life-threatening bleeds due to degree of coagulopathy. Endoscopy is indicated urgently in these patients.
- Urgent endoscopy in these patients will also allow reversal of anticoagulation for smallest possible period of time as reversing the anticoagulation puts these patients at risk of pump thrombosis and failure.
- Reversal of anticoagulation is a multi-disciplinary decision Haematology, cardiac surgery and gastroenterology all need to see the patient.
Stroke
Very high risk of stroke 10%3
Highest risk in the first 6 months post implant
Early CT head and CT angiography is needed when there is any suspicion of stroke.
Learning bite
You Cannot MRI LVAD patients
Ischaemic:
- Early consideration of thrombolysis systemic or targeted intra-arterial. This needs to be a stroke specialist decision.
- Consider thrombectomy
Haemorrhagic:
- Reversal of anticoagulation with prothrombin complex concentrate Again an MDT decision utilising the VAD specialists and haematologists