title: Acquired and Hereditary Hypercoagulable States in Patients with Continuous Flow Left Ventricular Assist Devices: Prevalence and Thrombotic Complications.
abstract: BACKGROUND
  Thrombotic events in patients with continuous flow left ventricular assist devices (CF-LVADs) are associated with significant morbidity and mortality. The objective of this study was to delineate the frequency, clinical characteristics, and outcomes of patients with hypercoagulable states who undergo CF-LVAD implantation.
  
  
  METHODS
  We performed a retrospective review of 168 consecutive patients who underwent CF-LVAD implantation between 2010 and 2013. Chart and laboratory data were reviewed for the presence of a hereditary and/or acquired hypercoagulable state. Adverse outcomes were defined as death, confirmed pump thrombosis, aortic root clot, stroke, deep vein thrombosis, and pulmonary embolism. Fisher's exact test and Kaplan-Meier estimate were used to analyze frequency of adverse outcomes and event free survival, respectively.
  
  
  RESULTS
  A hypercoagulable state was identified in 20 patients (11.9%). There were 18 patients with acquired, 1 with a congenital, and 1 with both congenital and acquired hypercoagulable states. The median follow-up was 429 days and 475 days in patients with and without hypercoagulable states, respectively. During the study period, 15% (3/20) of the patients with a hypercoagulable state had a diagnosis of deep vein thrombosis vs 3% (4/148) of the patients without a hypercoagulable state (P = .030). Only patients with a hypercoagulable state had a subarachnoid hemorrhage (3/20 vs 0/148; P < .01). The event-free survival was lower in the patients with hypercoagulable states (P = .005).
  
  
  CONCLUSIONS
  Hypercoagulable states are not uncommon in patients with CF-LVADs and may be associated with increased morbidity. Prospective studies are needed to more accurately identify the incidence, prevalence, and significance of hypercoagulable states in patients being considered for CF-LVAD.
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Paulino
authors.initials: P
authors.lastname: Alvarez
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Cordero-Reyes
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Cesar
authors.initials: C
authors.lastname: Uribe
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Patricio
authors.initials: P
authors.lastname: De Hoyos
authors.affiliation: Houston Methodist J.C. Walter Transplant Center, Houston, Texas.
authors.forename: Donna
authors.initials: D
authors.lastname: Martinez
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Arvind
authors.initials: A
authors.lastname: Bhimaraj
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Barry H
authors.initials: BH
authors.lastname: Trachtenberg
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Guha
authors.initials: G
authors.lastname: Ashrith
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Catedra de Cardiologia y Medicina Vascular, Tecnologico de Monterrey, Nuevo Leon, Mexico.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Houston Methodist J.C. Walter Transplant Center, Houston, Texas.
authors.forename: Mathias
authors.initials: M
authors.lastname: Loebe
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
authors.forename: Javier
authors.initials: J
authors.lastname: Amione-Guerra
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rice
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Houston Methodist J.C. Walter Transplant Center, Houston, Texas. Electronic address: jestep@houstonmethodist.org.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Estep
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019851:Thrombophilia / Q000151:congenital / Q000175:diagnosis / Q000209:etiology*; D013927:Thrombosis / Q000209:etiology*
keywords: HIT; Hypercoagulable states; left ventricular assist device; thrombosis