Clinical Impact of Hematoma Expansion in Left Ventricular Assist Device Patients.

Abstract: Introduction Hematoma expansion (HE) is associated with poor outcome in intracerebral hemorrhage (ICH) patients, but the impact on left ventricular assist device (LVAD) patients is unknown. We aimed to define the occurrence of HE in the LVAD population and to determine the association between HE and mortality. Materials & Methods We performed a retrospective cohort study of LVAD patients and intentionally matched anticoagulated controls without LVAD admitted to Columbia University Irving Medical Center with ICH between 2008 and 2019. We compared HE occurrence between LVAD and non LVAD patients using regression modeling adjusting for factors known to influence HE. We evaluated pump thrombosis following anticoagulation reversal. We examined the association between HE and hospital mortality using Poisson regression modeling adjusting for factors associated with poor outcome. Results Of 605 LVAD patients, we identified 28 patients with ICH meeting inclusion criteria. Our LVAD ICH cohort was predominantly male (71%), and mean age was 56 (+/-10) years. Median (interquartile range [IQR]) baseline hematoma size was 20.1 ml3 (8.6-46.9) and median (IQR) ICH score was 1 (1-2). There was no significant difference in occurrence of HE in LVAD patients and matched non-LVAD patients (adjusted OR 1.3, 95% CI 0.4-4.2). There was an association between HE and in-hospital mortality in LVAD patients (adjusted OR 4.8, 95 % CI 1.4–6.2). Conclusions HE occurrence appears similar between LVAD and non-LVAD patients and HE has a significant impact on LVAD ICH mortality, emphasizing the importance of adequate coagulopathy reversal and blood pressure management in these patients.