Spontaneous subarachnoid hemorrhage and acute hydrocephalus in a patient with a Left Ventricular Assist Device (LVAD)

Abstract

Intracranial hemorrhages associated with new generation left ventricular assist devices (LVAD) are increasingly reported as the use of these life saving devices is becoming more common, but few data are currently available to guide the acute management of these critically ill patients. This is a case presentation of a 33-year-old woman status post LVAD implantation on therapeutic anticoagulation who developed acute headache followed by rapidly progressive impairment of consciousness secondary to spontaneous subarachnoid hemorrhage and hydrocephalus. After discontinuation of heparin infusion, the patient underwent external ventricular drain placement(EVD)and her mental status fully recovered. Her work-up was negative for aneurysmal sources of bleeding. She received daily aspirin for 7 days for antiplatelet effect during which she did not experience any thromboembolic events related to the LVAD. At day 6 the EVD was clamped for 24 hours and her neurological exam remained intact. The EVD was removed and she was restarted on heparin infusion without further complications. Our experience suggests that in case of subarachnoid hemorrhage in patients with LVADs, temporary suspension of anticoagulation and EVD placement is safe and can lead to good neurological outcome.