Early signatures of bleeding and mortality in patients on left ventricular assist device support: novel methods for personalized risk-stratification

Abstract

Background: Left ventricular assist devices (LVADs) provide support for patients with end-stage heart failure. The aims of this study were to determine whether baseline analysis and early trends in routine laboratory data, platelet activity, and thromboinflammatory biomarkers following LVAD implantation reveal trends that predict personalized risks of one-year gastrointestinal (GI) bleeding, stroke, pump thrombosis, drive-line infections and mortality in patients on LVAD support.

Methods: We performed an observational study at the University of Kentucky with 61 participants who underwent first-time LVAD implantation. Blood was collected at baseline and post-op days 0, 1, 3 and 6 as well as clinical follow-up. Demographics, clinical characteristics, one-year adverse events and routine laboratory data were collected from electronic medical records. Platelet function and plasma biomarkers were profiled.

Results: Evaluation of routine laboratory results revealed that sustained thrombocytopenia and increased mean platelet volume (MPV) were associated with development of GI bleeding and mortality. Platelet function at follow-up visit predicted one-year bleeding events. Thrombotic biomarker sCD40L strongly predicted one-year GI bleeding at baseline before implantation and within the first week following LVAD implant.

Conclusions: Early trends in routine bloodwork and platelet function may serve as novel signatures of patients at risk to experience adverse events.

Keywords:

• Platelet
• inflammation
• VAD
• thrombocytopenia
• MPV

Acknowledgements

We would like to thank members of the Ventricular Assist Device team at the University of Kentucky for their assistance in this project.

Disclosure statement

None of the authors have any conflicts of interest to disclose.

Additional information

Funding

Tara Shrout was supported by the University of Kentucky College of Medicine Professional Student Mentorship Research Fellowship Award and by the University of Kentucky Clinical and Translational Science TL1 Award (TL1TR001997). Dr. Susan Smyth is supported by the UL1TR000117 (NIH National Center for Advancing Translational Sciences) and the R01HL120507 (NIH Heart Lung and Blood Institute).