Patients with advanced heart failure on long-term left ventricular assist device (LVAD) support develop progressive changes in blood clotting function over time, despite overall improvements in cardiac and organ function, according to new research.
Continuous-flow LVADs are increasingly used as a bridge to transplant or as long-term therapy. While they improve survival, patients remain at risk for bleeding, pump thrombosis, and ischemic stroke.
In a study of 85 patients, only 22 completed all follow-up visits. Using the Calibrated Automated Thrombogram assay, researchers observed a progressive shift toward a hypocoagulable state-reduced clotting ability-over several years. Thrombin generation lagtime increased significantly, while thrombin potential and peak concentration declined.
Notably, these coagulation changes occurred alongside improvements in heart failure markers: albumin and hemoglobin rose, while bilirubin, creatinine, and NT-proBNP fell-indicating better cardiac performance and organ perfusion.
However, despite these gains, the altered coagulation profile suggests ongoing disturbances in hemostasis during prolonged mechanical support. The mechanisms remain unclear and require further investigation.
The study was limited by its small sample size but provides rare longitudinal insight. Future research may explore whether serial thrombin generation monitoring could guide personalized anticoagulation strategies to reduce bleeding and thrombotic risks.