LVADs are a mainstay of treatment for patients with advanced heart failure.  LVADs are prothrombotic and require antiplatelet and anticoagulation therapy to prevent thromboembolism and pump thrombosis. These patients are at increased risk of bleeding from anticoagulation and LVAD induced Von Willebrand factor deficiency.  This dichotomy presents a unique challenge when treating patients after ischemic stroke. This study aims to determine risk factors for ischemic stroke (IS) post LVAD placement and hemorrhagic conversion (HC).

This retrospective chart review examined all patients with an LVAD.  Clinical and laboratory data were abstracted from medical records included vital signs, aPTT/INR, and discharge disposition. Imaging studies were reevaluated for the location and size of the ischemic infarct, as well as HC and reinfarction. Data was analyzed using two sample t-tests and chi square.

Ninety-nine patients were reviewed.  Twelve (60%) IS occurred in the first 100 days post LVAD placement.  Diabetes was more common in patients with strokes (p = 0.013). Two (10%) patients had HC without clinical change.  Their average INR was 4.6 compared to 2.4 in those without HC (p = 0.094). There was no difference in NIHSS (p = 0.72), days post LVAD placement (p = 0.39), or size of infarct (p = 0.97).   One patient had a new infarct 11 days after the first while therapeutic on heparin and warfarin.  Post infarct all patients had therapeutic PTTs/INRs.

Continuing therapeutic anticoagulation post infarct did not cause an increase in HC. Those that did have HC were found to have higher INRs, but the hemorrhage did not cause a clinical change.  Additionally, LVAD patients had ischemic strokes when their INR was therapeutic, but they appeared to be more thrombogenic in the first 100 days post implantation.