title: Predictors of Thromboembolic Events in Patients with Ventricular Assist Device.
abstract: Ventricular assist device patients (VAD) are at increased risk for thromboembolism. Biomarkers of hemolysis, such as lactate dehydrogenase (LDH) and poorly controlled international normalized ratio (INR) has been identified as predictors of thromboembolism. Patients aged 19 years and older who had a continuous flow VAD placed from 2006 to 2012 were included in this study (N = 115). We assessed the relationship of LDH elevation (≥600 IU/L) at different time points and thromboembolism. Over the 51.3 person-years of follow-up, a total of 23 first thromboembolic events occurred. Patients with elevated LDH on the day of VAD implantation had an increased risk for thromboembolism (hazard ratio [HR]: 4.72, 95% confidence interval [CI]: 1.44-15.4; p = 0.01). There was an increased risk of thromboembolism with early LDH elevation within the first month post-VAD (HR: 4.95, 95% CI: 1.69-14.4; p = 0.003) and estimated glomerular filtration rate <30 before VAD implantation (HR: 4.74, 95% CI: 1.12-20.1; p = 0.0346), whereas there was a decreased risk with good anticoagulation control (HR: 0.30, 95% CI: 0.10-0.86; p = 0.0247). Our study is the first to highlight the association between LDH elevation on the day of implantation and post-VAD thromboembolism. This study details the increased risk of thromboembolism with early LDH elevation and the importance of maintaining time in therapeutic INR range.
authors.affiliation: From the *Department of Epidemiology, School of Public Health, †Department of Neurology, School of Medicine, ‡Division of Cardiovascular Diseases, Department of Medicine, §Division of Cardiothoracic Surgery, Department of Surgery, and ¶Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.forename: Salpy V
authors.initials: SV
authors.lastname: Pamboukian
authors.forename: James F
authors.initials: JF
authors.lastname: George
authors.forename: Chrisly
authors.initials: C
authors.lastname: Dillon
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.forename: Russell
authors.initials: R
authors.lastname: Griffin
authors.forename: T Mark
authors.initials: TM
authors.lastname: Beasley
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
authors.forename: Nita A
authors.initials: NA
authors.lastname: Limdi
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D005260:Female; D006305:Health Status Indicators; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D019934:International Normalized Ratio; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood* / Q000209:etiology
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D007770:L-Lactate Dehydrogenase