Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices: Prevalence and Thrombotic Complications

The 18th Annual Scientific Meeting



S87

HFSA

Table 1 (219). In-hospital Outcomes of Patients placed on VA ECMO by Indication

Acute Cardiac (n528) Died 12 (43%)

Lived 14 (57% includes transfers)

Post-Cardiotomy (n535) Transferred 2

Other (n517)

Chronic Heart Failure(n513)

Died

Lived

Died

Lived

Died

Lived

24 (69%)

11 (31% includes 1 transfer)

14 (82%)

3 (18%)

7 (54%)

6 (46%)

Lawrence Rice2, Guillermo Torre-Amione1, Jerry D. Estep1; 1Houston Methodist Hospital, Houston, TX; 2Houston Methodist Hospital, Houston, TX

Figure 1. Percentage Survival to Discharge of Patients placed on. VA ECMO patients stratified by Indication.

220 Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices: Prevalence and Thrombotic Complications Paulino Alvarez1, Andrea M. Cordero-Reyes1, Mahwash Kassi1, Cesar Uribe1, Patricio DeHoyos2, Arvind Bhimaraj1, Barry H. Trachtenberg1, Guha Ashrith1,

Introduction: Recently an increase in pump thrombosis has been reported in patients with continuous flow left ventricular assist devices (CFLVAD). The cause of this phenomenon remains unclear. Guidelines recommend that patients with a history of thrombophilia have a hypercoagulable assessment before implant (Class I, level C). The objective of this study was to estimate the frequency and analyze the impact of inherited and acquired hypercoagulable states in patients with CFLVADs. Methods: We performed a retrospective review of patients who received a HeartMate II CFLVAD at our center between 2010-2013 for the presence of hypercoagulable states. Hereditary hypercoagulable state was defined as a history anti-thrombin, protein C or protein S deficiency or factor V Leiden or prothrombin FII20210A mutation prior to CFLVAD implantation. Acquired hypercoagulable states were defined as a history of myeloproliferative disorders, active cancer, hyperhomocysteinemia, antiphospholipid syndrome or heparin induced thrombocytopenia. Laboratory data prepost implantation was reviewed for the presence of lupus anticoagulant (LAC) and antiplatelet factor 4 (APF-4)antibodies. APF-4 antibodies were considered weakly positive and positive if optical density value was 0.4 to 1.39 and $ 1.40 respectively. Clinical and demographic variables were recorded for each patient. Adverse outcomes were defined as death, TIA or stroke, and/or documented aortic root clot and/or pump thrombosis. Results: A total of 172 patients underwent CFLVAD insertion during the study period, mean age was 56 (613) years-old and 30% were female. 19 (11%) patients with an acquired and/or hereditary hypercoagulable state were identified (table). Thrombotic complications in this group of patients included: definitive pump Thrombosis in 2 and aortic root thrombosis in 2 patients. Ischemic stroke complicated the perioperative period in one patient and postoperative period in one patient. Conclusions: A total of 6 arterial thrombotic complications occurred in 19 patients (31%). One year survival in this group was 79%. Our findings although limited by the retrospective nature and the intrisic bias of thrombophilia testing highlight the importance of hypercoagulable state evaluation in patients with CFLVAD given the potential for increased morbidity. Future prospective studies in this patient population are needed.

Table (220).

Hypercoagulable state Essential thrombocythemia Factor V Leiden HIT perioperative strong HIT perioperative strong HIT perioperative weak HIT perioperative weak HIT perioperative weak HIT perioperative weak HIT perioperative weak postoperative strong HIT postoperative strong HIT and LAC perioperative Lupus anticoagulant+ Lupus anticoagulant+ Lupus anticoagulant+ Lupus anticoagulant+ Lupus anticoagulant+ Lupus anticoagulant+ Multiple myeloma PC defficiency and LAC perioperative

Age

Sex

Goal of therapy

66 66 66 65 39 71 59 55 48 48 59 69 54 54 40 24 57 74 28

F M F M M M M M M M M M M F F F F M F

DT DT DT BTD BTT DT DT DT DT BTT BTD DT BTD DT BTT DT BTT DT DT

Thrombotic complications Aortic Root Thrombosis Deep Vein Thrombosis Death None Death Pump Thrombosis/Exchange Death Pump Thrombosis/Exchange CVA Ischemic /Death None None None Aortic Root Thrombosis Death None CVA Ischemic None None None

Timing (Postoperative day) 29 11 9 5 157 105 896 403/893

78 371 7 NA NA