Incidence of recurrent major bleeding and its impact on survival in LVAD patients: a multistate analysis

Introduction Major bleeding frequently complicates the clinical course of left ventricular assist device (LVAD) therapy. However, data on recurrent major bleeding in destination therapy (DT) patients, as well as its impact on survival, is limited. Methods: Single-center cohort of 122 predominantly DT LVAD between 2010-2024. A multistate model was estimated to evaluate first and recurrent major bleeding, and all-cause mortality. Patients who died within 14 days following implantation were excluded from the analysis. Results: For the final analysis 116 patients (90 Heartware HVAD; 26 HeartMate3) were included; median age at implantation was 64 years (IQR 59-69 years), 80% were male and 56% had ischemic heart failure. During a follow-up period totaling 300 patient-years, 155 major bleeding episodes occurred in 60 patients. Half of the patients who experienced a first major bleeding (n= 60) went on to develop a subsequent recurrence (n= 30). Recurrence often occurred within a short interval after the initial major bleeding. Among these recurrences, 43% occurred at the same site as the initial major bleeding. Conclusion: Following an initial major bleeding, LVAD patients frequently experienced either recurrent major bleeding or death within a short interval. The overall incidence of (recurrent) major bleeding was high. These findings highlight the burden of recurrent bleeding events and their impact in DT LVAD patients.