(278) - Heart Failure Etiology Influences Outcomes after Continuous-Flow LVAD Implantation

Abstract

s S111 Methods: CF-LVAD patients at a single academic institution were included in this study. ASA responsiveness was determined by a turbidimetric based optical based assay (VerifyNow). Results were expressed in Aspirin reaction units (ARU), which is calculated as a function of the rate and extent of platelet aggregation. Therapeutic resistance was defined as ARU level of > 550. Results: 84 CF-LVAD patients had assessment of platelet reactivity. There was a significant dose-response relationship observed between ASA dose used and ARU level measured in CF-LVAD patients (0 mg: 596.6 ARU, 81 mg: 540.2 ARU, 325 mg: 527.9 ARU, p= 0.002). 11 patients were not taking ASA at the time of testing due to gastrointestinal bleeding (GIB), epistaxis, or thrombocytopenia. Interestingly, 4 of these patients (36.6%) had evidence for platelet dysfunction, even in absence of ASA therapy. Prevalence of ASA resistance in patients who were on ASA therapy at the time of testing was 52.9% (36/68). Incidence of pump thrombosis was not significantly different between in ASA sensitive versus ASA resistant patients (12.5% vs. 16.7%, p= 0.739). However, there was significantly higher incidence of mucosal bleeding (GIB or epistaxis) in ASA sensitive patients when compared to ASA resistant patients (43.8% vs. 19.4%, p= 0.030). Mean platelet reactivity was significantly lower in patients who experienced mucosal bleeding versus who did not on CF-LVAD support (509.8±72.7 vs. 548.8±45.5, p= 0.031). Conclusion: ASA responsiveness is highly variable and is associated with mucosal bleeding events in patients on CF-LVAD support. Assessment of platelet function can help identify patients at risk for bleeding complications and thereby help personalize anti-thrombotic therapies in this population.