Gastrointestinal Bleeding, International Normalized Ratio, and Subsequent Risk of Recurrent Thromboembolic Events among Left Ventricular Assist Device Patients

Purpose Patients have an increased risk of gastrointestinal bleeding (GIB) and thromboembolic events (TE) after left ventricular assist device (LVAD) implantation. We hypothesized that GIB in LVAD recipients leads to low international normalized ratio (INR) values that may predispose to increased risk of TE. Methods This study included 410 patients in the University of Rochester Medical Center LVAD Database who were implanted between 2008 and 2020 (mean age 56 ± 13 years, 80% male, 84% white). Longitudinal data on INR was categorized as therapeutic (2-3), sub-therapeutic ( 3). A TE event was defined as device malfunction, confirmed or suspected pump thrombosis, ischemic stroke, transient ischemic attack, venous thromboembolism, or arterial non-CNS thromboembolism. The primary outcome was recurrent TE. The Anderson-Gill recurrent regression analysis was used to obtain hazard ratios and confidence intervals. Results During median follow-up of 2.07 years 83 (20%) patients had TE. After multivariate adjustment, GIB was associated with a 28% increased likelihood for subsequent sub-therapeutic INR values ( Conclusion Our findings suggest that the occurrence of GIB following LVAD implantation may predispose to increased risk of recurrent TE through sub-therapeutic INR values. INR