title: Anticoagulation and bleeding in patients with ventricular assist devices: walking the tightrope.
abstract: A left ventricular assist device (LVAD) is a lifesaving therapy for end-stage heart failure, but it is associated with major complications such as bleeding and thrombosis. Anticoagulation is an important part of LVAD therapy; it requires meticulous management and monitoring for prevention of thromboembolic and bleeding events. Recommendations for thromboprophylaxis vary among pulsatile and nonpulsatile devices and require multiple pharmacological agents to achieve adequate anticoagulation. Patients expected to undergo LVAD implantation must have a comprehensive evaluation for underlying coagulopathies. During the perioperative period, all measures must be taken to prevent excessive bleeding and maintain hemostasis. Postoperative bleeding and thromboembolic episodes must be minimized to prevent significant complications of ventricular assist device therapy. Bleeding and thromboembolism are an impediment to a patient's quality of life as they can result in multiple hospitalizations, along with serious consequences such as death and permanent disability.
authors.affiliation: Advocate Christ Medical Center, 4400 W 95th St., Oak Lawn, IL 60453, USA. sudha.kurien@advocatehealth.com
authors.forename: Sudha
authors.initials: S
authors.lastname: Kurien
authors.forename: Kylie A
authors.initials: KA
authors.lastname: Hughes
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D004844:Epistaxis / Q000139:chemically induced; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006461:Hemolysis; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011183:Postoperative Complications; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced; D013927:Thrombosis / Q000139:chemically induced
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors