Risk factors for thromboembolic events in pediatric patients with ventricular assist devices
Retrospective cohort published in JTCVS Open (2024)
Abstract
OBJECTIVE: Pediatric patients on ventricular assist devices (VAD) are at risk of thromboembolic (TE) complications. Our objective was to identify factors associated with TE events, including the role of initial anticoagulation strategy and device type in the pediatric VAD population. METHODS: This was a retrospective, single-center review (2005-2022) of children who were implanted with paracorporeal pulsatile (PP), paracorporeal continuous (PC), or a combination of devices. Patient- and device-related factors were collected. Kaplan-Meier survival analysis was performed to determine freedom from TE. Cox proportional hazard analysis was conducted to look for factors associated with TE events. RESULTS: Ninety-five patients included with a median age of 0.9 years (interquartile range, 0.3, 5.4); median weight of 8.4 kg (interquartile range, 4.5, 17.8), and 63.2% with noncongenital heart disease. Device breakdown included 47.4% PC, 24.2% PP, and 23.2% combination of devices. Initial anticoagulation was either heparin (61.5%) or bivalirudin (38.5%). In Kaplan-Meier analysis, unadjusted freedom from a TE event was significantly greater in those who received bivalirudin as their initial anticoagulation strategy (P = .02) and PP VADs (P = .02). In multivariate analysis, initial anticoagulation strategy with bivalirudin (hazard ratio, 0.30; 95% confidence interval, 0.12-0.75, P = .01) was associated with a reduced hazard of TE events, whereas PC device strategy was found to be associated with an increased hazard (hazard ratio, 2.78; 95% confidence interval, 1.12-6.88, P = .03). CONCLUSIONS: This study suggests that PC device strategy and heparin as an initial anticoagulation strategy are associated with increased hazard of TE events. Further research is required to understand the interaction between device type and initial anticoagulation strategy.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Single-center cohort of 95 pediatric VAD patients (2005-2022); bivalirudin as initial anticoagulation was associated with reduced hazard of thromboembolic events (HR 0.30, p=0.01) compared with heparin.
Why This Matters for Hirudotherapy
This retrospective single-center review (2005-2022) of 95 pediatric ventricular assist device patients examined risk factors for thromboembolic events, including initial anticoagulation strategy (heparin 61.5% vs. bivalirudin 38.5%) and device type. Multivariate analysis found bivalirudin as initial anticoagulation was associated with reduced thromboembolic hazard (hazard ratio 0.30, 95% confidence interval 0.12-0.75, p=0.01), while paracorporeal continuous devices were associated with increased hazard (hazard ratio 2.78). The authors conclude that paracorporeal continuous device strategy and heparin as initial anticoagulation are associated with increased hazard of thromboembolic events, and that further research is required. The abstract does not mention hirudin, leeches, leech therapy, or the leech secretome, so no connection to hirudotherapy is established.
Citation
Risk factors for thromboembolic events in pediatric patients with ventricular assist devices.
Adderley J et al. · JTCVS Open, 2024
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