Abstract TP71: Interruption of Antiplatelet and Anticoagulant Therapy Does Not Increase Risk of Recurrent Stroke in Patients with Left Ventricular Assist Devices

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jenny Peih-Chir Tsai ◽  
Christopher Barrett ◽  
Neil E Schwartz ◽  
Dipanjan Banerjee
Keyword(s):  
Median Time ◽  
Antithrombotic Therapy ◽  
Combined Therapy ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Time To Recurrence ◽  
Cerebrovascular Events ◽  
Left Ventricular Assist

Introduction: Left ventricular-assist devices (LVAD) have increased survival and quality of life of patients with heart failure. Patients with LVAD have increased risks of ischemic and hemorrhagic cerebrovascular events due to device thrombosis and combined use of antiplatelet and anticoagulant agents. The safety of transient interruption of combined antithrombotic therapy after stroke is unknown. Hypothesis: Time to resumption of combined antiplatelet and anticoagulant therapy after stroke is not associated with the incidence of recurrent cerebrovascular event. Methods: We defined the study cohort of patients who received an LVAD using ICD-9 codes. We obtained data for patients with new cerebrovascular events while on a Heartmate-II or Heartware LVAD, and excluded those deceased from the initial event. We divided patient-events into two cohorts based on the index event: ischemic (TIA, stroke) or hemorrhagic (all intracranial hemorrhages, ICH). We used Fisher’s exact test to assess the association between recurrent ischemic event or ICH and time off combined antithrombotic therapy. We pre-specified variables for adjustment in the logistic regression analysis: age, cardiovascular risk factors, LVAD model, indication and endpoint, NIHSS score, INR and LDH levels, and baseline and change in antithrombotic therapy. Results: The study included 48 patient-events between 2011 and 2016: 23 (48%) were ischemic (9 (40%) TIA and 14 (60%) infarcts) and 25 (52%) hemorrhagic. The ischemic event cohort had 9 (39%) recurrences, including 6 (67%) ischemic and 3 (33%) ICH. Median time to recurrence was 118 (IQR 78-388) days. All patients continued on antiplatelet, and maximum time off anticoagulant was 2 (median 0) days. Time off combined therapy was not associated with ischemic (p=0.43) or hemorrhagic recurrence (p=1.00). The ICH cohort had three (12%) recurrences: 1 (33%) ischemic and 2 (67%) hemorrhagic. Median time to recurrence was 158 (IQR 32-586) days. Median time off combined therapy was 7 (0-15) days, and not associated with ischemic (p=0.43) or hemorrhagic recurrence (p=0.83). Conclusion: In patients with LVAD, transient interruption of combined antithrombotic therapy after stroke is not associated with increased risk of recurrent cerebrovascular events.

Abstract W P163: Ischemic and Hemorrhagic Cerebrovascular Events after Left Ventricular Assist Devices

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Pouya Tahsili-Fahadan ◽  
David R Curfman ◽  
Albert A Davis ◽  
Noushin Yahyavi-Firouz-Abadi ◽  
Michael E Nassif ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Cerebrovascular Events ◽  
Left Ventricular Assist ◽  
Lvad Support

Introduction: Left ventricular assist devices (LVADs) are increasingly implanted for advanced heart failure either as a bridge to transplantation (BTT) or destination therapy (DT). The reported incidence of cerebrovascular events (CVE) following LVAD is 8-25%. The effects of medical comorbidities and perioperative events on the development of CVE are unclear. Methods: CVEs were retrospectively identified from the Barnes-Jewish Hospital LVAD database consisting of 373 patients with mean LVAD support of 13.5 months (range 0 days-8.2 years); Heartmate II 87%, Heartware 13%. Demographic, clinical, and outcome data were collected and analyzed in patients with and without CVE using standard statistical methods. Results: CVE occurred in 71 patients (19%) at a rate of 0.17 per patient-year 24.5±30.7 months after implantation. Coronary artery disease (P=0.007), diabetes mellitus (P=0.02) and LVAD indication of DT (P=0.04) were more common in patients with CVEs. Duration of cardiopulmonary bypass, hospital length of stay and incidence of bacteremia were not different between those with early CVE (within 30 days of implantation, 35%) and without CVE. CVEs were ischemic (ICVE) in 35 (49%), hemorrhagic (HCVE, including intracerebral, subarachnoid, and subdural) in 26 (37%), and both in 10 (14%). Patients with ICVE and HCVE did not differ in demographic variables, pre-LVAD co-morbidities, post-LVAD complications, NIH Stroke Scale at time of event, or anti-thrombotic regimen (ATR), except that events in those on no ATR were only ischemic. Patients with HCVEs were more likely to be discharged with no ATR (P=0.015). Mortality was significantly higher in patients with CVE (59.1% vs. 29.2% in those without CVE) but did not differ by CVE type. In patients with CVE, 57.1% of deaths were secondary to the CVE (ICVE 25%, HCVE 93.7%, P<0.001). Among BTT patients, only 14.6% with CVE underwent transplantation vs. 39.8% without CVE (P =0.002). Conclusions: CVE remains a serious complication of LVAD support for advanced heart failure and is associated with increased mortality and lower rates of heart transplantation. Further investigations to identify risk factors for CVEs in LVAD patients and potential preventive measures including optimal ATRs are warranted.

Cerebrovascular Events After Continuous-Flow Left Ventricular Assist Devices

2018 ◽  
Vol 29 (2) ◽  
pp. 225-232 ◽  
Author(s):  
Pouya Tahsili-Fahadan ◽  
David R. Curfman ◽  
Albert A. Davis ◽  
Noushin Yahyavi-Firouz-Abadi ◽  
Lucia Rivera-Lara ◽  
...  
Keyword(s):  
Continuous Flow ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Cerebrovascular Events ◽  
Left Ventricular Assist

scholarly journals 94. Infectious Complications of Left Ventricular Assist Devices

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Courtney Harris ◽  
Lara Coakley ◽  
Mandeep R Mehra ◽  
Hari R Mallidi ◽  
Lindsey R Baden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Median Time ◽  
Infectious Complication ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Bleeding Complications ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

Abstract Background Left ventricular assist devices (VAD) have significantly increased survival for patients with advanced heart failure. While advancements in devices during the past 10 years have improved thrombotic and bleeding complications, infection remains a significant cause of morbidity and mortality. We assessed the incidence and risk factors of VAD infections at our institution. Methods A single center, retrospective study of patients who had VAD implanted between January 2007 and December 2020 was performed. Patients with concurrent right sided mechanical circulatory support devices were excluded. Patient demographics, clinical characteristics, labs, microbiology data, and antimicrobials were obtained from the electronic medical records. Clinical outcomes were adjudicated by 2 independent physicians. VAD infections were classified using the ISHLT 2011 guidelines. Results 241 patients had durable VAD implanted in this 14-year period, with a median time of 3 years follow-up. 134 (56%) patients had a clinically significant infection; 42 (31.3%) were VAD specific infections, 42 (31.3%) were VAD related, and 50 (37.4%) were non-VAD related. 95% of VAD specific infections were driveline site infections. 98% of patients with VAD related infections had a concurrent blood stream infection. Of the 50 non-VAD infections, 72% involved either a lower respiratory, urinary tract, or Clostridium difficile infection. Median time from VAD implantation to infection was 5 months. 44 (32.8%) had their first infection during the index hospitalization, of which 27 (61.4%) were non-VAD infections. 78 (58.2%) had one infection, compared with 38 (28.4%) who had two or more infections. 17 (12.7%) had recurrence of their initial infection and 6 (35%) occurred despite being on suppressive antibiotics. 48 of 134 (36%) infected patients were transplanted. 57 of 134 (42.5%) died compared to 33 of 107 (31%) without an infection. Conclusion More than half of VAD patients at our center during a 14-year time period had an infectious complication and higher mortality rate compared to those without an infectious complication. Further studies are needed to assess the immunologic risk factors for the increased risk of non-device associated infections in VAD patients. Disclosures Mandeep R. Mehra, MD, Abbott (Consultant)Baim Institute for Clinical Research (Consultant)FineHeart (Consultant)NupulseCV (Consultant) Ann E. Woolley, MD, MPH, COVAX (Consultant)

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