Author + information
- Received March 13, 2014
- Revision received August 5, 2014
- Accepted August 8, 2014
- Published online February 1, 2015.
- Michael E. Nassif, MD∗,
- Jayendrakumar S. Patel, MD†,
- Jerrica E. Shuster, PharmD∗,
- David S. Raymer, MD∗,
- Ronald Jackups Jr., MD‡,
- Eric Novak, MS∗,
- Brian F. Gage, MD†,
- Sunil Prasad, MD§,
- Scott C. Silvestry, MD§,
- Gregory A. Ewald, MD∗ and
- Shane J. LaRue, MD, MPHS∗∗ ()
- ∗Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
- †Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- ‡Division of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
- §Division of Cardiovascular Surgery, Washington University School of Medicine, St. Louis, Missouri
- ↵∗Reprint requests and correspondence:
Dr. Shane J. LaRue, Cardiovascular Division, Washington University School of Medicine, Campus Box 8086, 660 South Euclid Avenue, St. Louis, Missouri 63110.
Objectives This study evaluated clinical outcomes associated with erythropoiesis stimulating agent (ESA) use in left ventricular assist devices (LVAD)–supported patients.
Background Use of ESAs in patients with LVADs may minimize blood transfusions and decrease allosensitization. ESAs increase thrombotic events, which is concerning because LVADs are sensitive to pump thrombosis (PT).
Methods We retrospectively reviewed 221 patients at our center who received a HeartMate II (Thoratec Corp., Pleasanton, California) LVAD between January 1, 2009 and June 6, 2013. Patients were divided into those who received ESAs during index admission (n = 121) and those who did not (n = 100). Suspected PT was defined as evidence of thrombus in the LVAD or severe hemolysis (lactate dehydrogenase >1,000 mg/dl or plasma-free hemoglobin >40 mg/dl). Outcomes were compared between cohorts using inverse probability-weighted analyses.
Results During a mean follow-up of 14.2 ± 11.9 months, suspected PT occurred in 37 patients (ESA 23%, no ESA 12%; p =0.03). The ESA cohort received ESAs 13.9 ± 60.9 days after LVAD implantation. At 180 days, event-free rates for suspected PT were ESA 78.6% versus no ESA 94.5% (p < 0.001). ESA use had higher rates of suspected PT (hazard ratio [HR]: 2.35; 95% confidence interval [CI]: 1.38 to 4.00; p = 0.002). For every 100-unit increase in cumulative ESA dosage, the hazard of suspected PT increased by 10% (HR: 1.10; 95% CI: 1.04 to 1.16; p < 0.001). After inverse probability weighting, ESA use was associated with a significantly higher rate of all-cause mortality (HR: 1.62; 95% CI: 1.12 to 2.33; p = 0.01).
Conclusions ESA use in LVAD patients is associated with higher rates of suspected PT.
This study was supported in part by research funds from the National Institutes of Health (NIH grant U10 HL110309, Heart Failure Network). Dr. Silvestry has served as a consultant for Thoratec and HeartWare. Dr. Ewald has received research support from Thoratec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 13, 2014.
- Revision received August 5, 2014.
- Accepted August 8, 2014.
- American College of Cardiology Foundation