Bleeding and Thrombotic Events in Patients Undergoing Mechanical Circulatory Support: A Review of Literature.
Bleeding and thrombotic events are among the most common complications detected in patients with mechanical circulatory support (MCS). Herein, we reviewed the available evidence on the prevalence, etiology, and management of bleeding and thrombotic events in patients following MCS procedures, such as implantation of both intra- and paracorporeal devices that generate either pulsatile or nonpulsatile flow. Extracorporeal life support procedures providing support to the failing heart and lungs were also reviewed. Most bleeding and thromboembolic events occur despite appropriate hemostatic and anticoagulation management based on conventional coagulation laboratory parameters. Prevalence of bleeding events in this population ranges between 5 and 81%. Wide range in prevalence of bleeding reported in literature may be explained by different devices with different anticoagulation protocols being used, as well as different definitions of bleeding outcomes. Although bleeding events are more common than thromboembolic events, the consequences of thrombotic events are often detrimental. Management of bleeding events remains challenging and measures to prevent and treat bleeding events are often followed by thromboembolic events. Therefore, a personalized approach based on point-of-care hemostatic tests and adjusted to device type and patient comorbidities is therefore warranted. To provide advanced understanding of hemostatic disturbances during MCS, prospective trials focused on bleeding and thromboembolic events as primary endpoints should be conducted. Better understanding of the underlying pathophysiology and a shift towards a personalized approach based on functional point-of-care hemostatic properties assessment may provide more favorable clinical outcomes. This should, however, be coupled with further technological improvements providing better device surface hemocompatibility as interaction between blood and device surface affects the hemostatic equilibrium.
Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Croatia.
Mate
M
Petricevic
Department of Cardiovascular Disease, University of Zagreb School of Medicine, University Hospital Center Zagreb, Croatia.
Davor
D
Milicic
Department of Cardiology, University Hospital "Thalassotherapia Opatija", Medical School University of Osijek and Rijeka, Osijek, Croatia.
Marko
M
Boban
Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Croatia.
Martina Zrno
MZ
Mihaljevic
Department of Cardiovascular Disease, University of Zagreb School of Medicine, University Hospital Center Zagreb, Croatia.
Zeljko
Z
Baricevic
Department of Radiology and Medical Diagnostics, University of Split School of Medicine, University Hospital Center Split, Split, Croatia.
Kresimir
K
Kolic
Department of Radiology and Medical Diagnostics, University of Split School of Medicine, University Hospital Center Split, Split, Croatia.
Kresimir
K
Dolic
Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Croatia.
Lucija
L
Konosic
Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Croatia.
Tomislav
T
Kopjar
Department of Cardiac Surgery, University of Zagreb School of Medicine, University Hospital Center Zagreb, Croatia.
Bojan
B
Biocina
D001780:Blood Coagulation Tests; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000295:instrumentation; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006470:Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006487:Hemostasis; D006801:Humans; D010107:Oxygenators, Membrane / Q000009:adverse effects*; D010979:Platelet Function Tests; D000067716:Point-of-Care Testing; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome