Prognostic Impact of Peri-Operative Thrombocytopenia on Outcomes of Left Ventricular Assist Device Implantation

Purpose This study evaluated the impact of peri-operative thrombocytopenia on outcomes following left ventricular assist device (LVAD) implantation. Methods Adults undergoing contemporary LVAD implantation (HeartMate 3 or HeartWare HVAD) between 2009 to 2018 at a single institution were included. Pre-, intra-, and post-op (within 72 hours) platelet nadirs were analyzed, and thrombocytopenia (TC) was defined as a nadir Results A total of 195 patients were included in the study. 48.7% experienced no TC at any phase (Group 1), 16.9% had only post-op TC (Group 2), 7.7% had only intra-op TC (Group 3), 18.0% had intra- and post-op TC (Group 4), 6.7% had TC at all phases (Group 5), and 2.1% had pre- and intra-op TC but no post-op TC (Group 6). In multivariable analysis, the presence of intra- (HR 2.50, 95% CI 1.15-5.45, p=0.02) and post-op (HR 2.32, 95% CI 1.07-5.06, p=0.03) TC were independent predictors of 1-year mortality following LVAD implantation although pre-op TC was not (HR 1.14, 95% CI 0.42-3.10, p=0.80). In assessing stratified groups, the 3 cohorts with post-op TC (Group 2, 4, 5) were the only patients with an increased risk-adjusted likelihood of 1-year mortality (Table). The post-op TC group also experienced higher rates of post-implant adverse events, including renal failure, hepatic dysfunction, bleeding, infection, and readmission (all, p Conclusion Pre-operative thrombocytopenia is not associated with 1-year mortality after LVAD implantation and therefore should not serve as an absolute contraindication to surgery. However, particular attention should be paid to appropriate platelet transfusion practice and patient management to avoid intra- and early post-operative thrombocytopenia as both are strong predictors of adverse outcomes.