Abstract 14574: Assessing Cardiovascular, Thrombotic and Bleeding Outcomes in Patients With Chronic Liver Disease Undergoing Left Ventricular Assist Device Implantation: Analysis of the National Inpatient Sample Database

Abstract

Introduction: Coagulopathy and hematologic abnormalities are major concerns in patients with chronic liver disease (CLD) and refractory heart failure which combined with the use of anticoagulation or anti-platelet therapy, may affect perioperative outcomes in patients undergoing left ventricular assist device (LVAD) implantation. Methods: The National Inpatient Sample Database was queried from 2012 to 2017 for relevant International Classification of Diseases (ICD)-9 and ICD-10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with chronic liver disease and those without, who underwent LVAD implantation. Results: A total of 23,435 patients underwent LVAD implantation, 2,200 patients with CLD and 20,755 patients without CLD. See Table 1 for baseline characteristics. All-cause inpatient mortality (14.8% vs. 11.1%, p<0.001), major bleeding (34.3% vs. 30.2%, p<0.001), transfusion of platelets (18.0% vs. 14.0%, p<0.001), and the occurrence of a subarachnoid hemorrhage (1.6% vs. 0.7%, p<0.001) were greater in patients with CLD. LVAD thrombosis (6.6% vs. 9.4%, p<0.001) and post-operative ischemic stroke (3.4% vs. 6.1%, p<0.001) occurred less in patients with CLD. Using a multivariate logistic regression model to adjust for confounding factors, revealed that CLD was predictive of increased mortality in patients undergoing LVAD implantation (odds ratio: 1.29, 95% confidence interval [CI]; 1.06 to 1.56, p=0.010). Conclusions: We demonstrated between 2012 to 2017, given the clinical paradox of pro- and anticoagulant risks in patients with CLD and advanced HF, LVAD implantation was associated with increased mortality, major bleeding with increased utilization of platelet products and yet increased thrombotic complications. Further studies are needed to evaluate both thrombotic and bleeding risks in this population, along with mitigating factors without compromising either outcome.