title: Intractable Hematuria After Left Ventricular Assist Device Implantation: Can Lessons Learned from Gastrointestinal Bleeding Be Applied?
abstract: Patients with continuous-flow left ventricular assist devices (CF-LVADs) are at increased risk of bleeding. We reviewed our institutional experience with bleeding in the urinary tract after CF-LVAD implantation and quantified the impact on hospital resource utilization in comparison with bleeding in the gastrointestinal (GI) tract, the most commonly reported mucosal site of bleeding after LVAD implantation. Records were retrospectively reviewed for patients undergoing CF-LVAD implantation at our institution between October 2011 and April 2015. Major adverse events of gross hematuria and GI bleeding were identified, and patient demographics and hospital course were reviewed. Gross hematuria occurred in 3 of the 35 patients (8.6%) and in 5.1% of all hospitalizations for CF-LVAD patients. Severe hematuria occurred after traumatic urethral catheterization, urinary retention, or urologic surgery. Hospitalization for hematuria was six times less likely than hospitalization for GI bleeding; however, hematuria hospitalizations lasted 3.2 times longer than GI bleeding hospitalizations (17.0 vs. 5.3 days). Late recurrent gross hematuria occurred in all cases, with rehospitalization occurring after 109 ± 53 days. In conclusion, gross hematuria is an infrequent but morbid bleeding complication in CF-LVAD patients. Strategies to avoid this complication include strict avoidance of traumatic urethral catheterization and urinary retention in high-risk patients.
authors.affiliation: From the *Department of Cardiothoracic Surgery, †Department of Urology, and ‡Division of Cardiology, New York University-Langone Medical Center, New York, New York.
authors.forename: Andre Y
authors.initials: AY
authors.lastname: Son
authors.forename: Lee
authors.initials: L
authors.lastname: Zhao
authors.forename: Alex
authors.initials: A
authors.lastname: Reyentovich
authors.forename: Abe
authors.initials: A
authors.lastname: Deanda
authors.forename: Leora B
authors.initials: LB
authors.lastname: Balsam
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006417:Hematuria / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects; D016055:Urinary Retention / Q000150:complications; D014551:Urinary Tract / Q000293:injuries
chemical_list: D000925:Anticoagulants