Management of Bleeding Associated with Durable Mechanical Circulatory Support

Heart failure patients that require mechanical circulatory support with a ventricular assist device (VAD) are at a high risk of bleeding due to the underlying physiology of their disease, the physical presence of the VAD, and the requirement of antithrombotic therapy. The VAD pump itself can influence hematologic, inflammatory, and immunologic parameters that can disrupt the hemostatic process. Continuous flow VADs are now more frequently used compared to the older, pulsatile flow devices due to their smaller size and reduced risk of thrombosis. These benefits are marginally offset by the higher risk of gastrointestinal bleeding seen in patients using continuous flow devices. It is important that healthcare providers responsible for the management of these patients be prepared to deal with potential bleeding events appropriately.