TY - JOUR
T1 - Bleeding and thrombotic events occur early in children on durable ventricular assist devices
AU - Huang, Joanna Y.
AU - Ignjatovic, Vera
AU - Sheridan, Bennett J.
AU - Mathew, Jacob
AU - D'Udekem, Yves
AU - Brink, Johann
AU - Barton, Rebecca
AU - Callea, Gabrielle
AU - Morsman, Dominique
AU - Donath, Susan
AU - Opat, Stephen
AU - Monagle, Paul
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Introduction: Durable Ventricular Assist Devices (VADs) are increasingly used in children with end-stage heart failure. Major complications are bleeding and thromboembolism (TE). Our objective was to determine the timing, incidence and risk factors for bleeding and TE in children implanted with VADs. Methods: This was a retrospective cohort of 8 years experience for children implanted with HeartWare HVAD and Berlin Heart EXCOR VADs at the Royal Children's Hospital, Melbourne. Results: 44 patients were implanted with Berlin Heart EXCOR or HeartWare HVAD devices. Major bleeding occurred in 17 patients (39%), 7 (16%) experienced thromboembolic strokes, 13 (30%) required device exchange for TE, and 4 (9%) experienced arterial thromboembolism. Twenty-seven patients (61%) were transplanted, three (7%) recovered, and six (14%) remain on device when censored. Eight patients (18%) died on VAD, with leading causes being thromboembolic stroke and intracranial bleeding. The majority of bleeding events and thromboembolic events occurred while patients were on unfractionated heparin (bleeding 66%, TE 40.5%) or transitioning between heparin and warfarin (bleeding 22%, TE 38%). Majority of patients were on more than one antiplatelet agent at the time of a major bleeding (87%) or thromboembolic (89%) event. Conclusions: The majority of bleeding and TE events occurring in children supported with durable VADs occur when they are on unfractionated heparin or transitioning to warfarin. Modifications to anticoagulation and monitoring in the early post-operative periods should be a research focus.
AB - Introduction: Durable Ventricular Assist Devices (VADs) are increasingly used in children with end-stage heart failure. Major complications are bleeding and thromboembolism (TE). Our objective was to determine the timing, incidence and risk factors for bleeding and TE in children implanted with VADs. Methods: This was a retrospective cohort of 8 years experience for children implanted with HeartWare HVAD and Berlin Heart EXCOR VADs at the Royal Children's Hospital, Melbourne. Results: 44 patients were implanted with Berlin Heart EXCOR or HeartWare HVAD devices. Major bleeding occurred in 17 patients (39%), 7 (16%) experienced thromboembolic strokes, 13 (30%) required device exchange for TE, and 4 (9%) experienced arterial thromboembolism. Twenty-seven patients (61%) were transplanted, three (7%) recovered, and six (14%) remain on device when censored. Eight patients (18%) died on VAD, with leading causes being thromboembolic stroke and intracranial bleeding. The majority of bleeding events and thromboembolic events occurred while patients were on unfractionated heparin (bleeding 66%, TE 40.5%) or transitioning between heparin and warfarin (bleeding 22%, TE 38%). Majority of patients were on more than one antiplatelet agent at the time of a major bleeding (87%) or thromboembolic (89%) event. Conclusions: The majority of bleeding and TE events occurring in children supported with durable VADs occur when they are on unfractionated heparin or transitioning to warfarin. Modifications to anticoagulation and monitoring in the early post-operative periods should be a research focus.
KW - Bleeding
KW - Heart failure
KW - Mechanical circulatory support
KW - Pediatrics
KW - Thrombosis
KW - Ventricular assist device
UR - http://www.scopus.com/inward/record.url?scp=85056816669&partnerID=8YFLogxK
U2 - 10.1016/j.thromres.2018.11.019
DO - 10.1016/j.thromres.2018.11.019
M3 - Article
C2 - 30476715
AN - SCOPUS:85056816669
SN - 0049-3848
VL - 173
SP - 65
EP - 70
JO - Thrombosis Research
JF - Thrombosis Research
ER -