Cerebral hemorrhage in the LVAD patient: A case series and literature review

Abstract

IntroductionA left ventricular assist device (LVAD) is used in certain heart failure cases, but LVADs can have significant neurological complications including intracranial hemorrhages (ICH). Prediction and management of ICHs is challenging due to medical comorbidities and blood thinners. MethodsA retrospective review of LVAD patients with ICHs from 2015 to 2019 was performed. The data included demographics, premorbid conditions, hemorrhage type, treatments, and outcomes. ResultsTwenty-two patients were included with a median age of 53 and a median time of 16 months from LVAD insertion to ICH. All patients were on blood thinners prior to ICH. The hemorrhage type included subarachnoid hemorrhage (41 %), intracerebral hemorrhage (32 %), and subdural hematomas (23 %). The blood-thinning agent was reversed in 64 % of patients with a median of 3.5 days prior to resumption of these medications. Ten re-hemorrhages occurred with 4 of these hemorrhages within two weeks of anticoagulation resumption. Open cranial surgery was performed in 32 % of all patients, and the mortality was 41 %. ConclusionsManagement of these patients is challenging with a relatively high rate of re-hemorrhage and need for surgical intervention. Despite maximal management, the mortality remains high.