title: Mechanisms of bleeding and approach to patients with axial-flow left ventricular assist devices.
abstract: Axial-flow LVADs have become an integral tool in the management of end-stage heart failure. Consequently, nonsurgical bleeding has emerged as a major source of morbidity and mortality in this fragile population. The mechanisms responsible for these adverse events include acquired von Willebrand disease, GI tract angiodysplasia formation, impaired platelet aggregation, and overuse of anticoagulation therapy. Because of ongoing concerns for pump thrombosis and thromboembolic events, the thrombotic/bleeding paradigm has led to a difficult clinical dilemma for those managing patients treated with axial flow LVADs. As the field progresses, advances in the understanding of the pathological mechanisms underlying bleeding/thrombosis risk, careful risk stratification, and potential use of novel anticoagulants will all play a role in the management of the LVAD patient.
authors.affiliation: Duke Clinical Research Institute and the Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Suarez
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Richard
authors.initials: R
authors.lastname: Becker
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Rogers
mesh_terms: D001775:Blood Circulation / Q000502:physiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000503:physiopathology; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010974:Platelet Aggregation / Q000502:physiology; D012307:Risk Factors; D014842:von Willebrand Diseases / Q000453:epidemiology / Q000503:physiopathology