Key result
Minimized antithrombotics safely manage abnormal uterine bleeding in pediatric LVAD support without thrombosis.
Why the study?
Abnormal uterine bleeding is an often underreported gynecological complication in female patients with end-stage heart failure following LVAD implantation.
Case Report (n=1)
This case report demonstrates that in pediatric LVAD patients with severe abnormal uterine bleeding, a multidisciplinary approach utilizing reduced antithrombotic therapy and organ-preserving laparoscopic surgery can safely manage bleeding while preventing thromboembolism and preserving fertility.
AUB may warrant vigilance in adolescent LVAD recipients; single case leaves open prevalence and management questions.
Background: Mechanical circulatory support significantly improved survival in end-stage heart failure patients. However, this treatment associated with a wide range of complications, including infections, stroke and bleeding. Abnormal uterine bleeding (AUB) is often underreported gynecological disorder in female patients following left ventricular assist device (LVAD) implantation. Case Presentation: A 15-year-old female patient with dilated cardiomyopathy and chronic heart failure with reduced ejection fraction underwent implantation of “Heart Mate 3” as a “bridge” to transplant. After LVAD implantation she had recurrent nosebleeds and AUB complicated with moderate anemia. She frequently admitted to the hospital and then managed with antifibrinolytic medication (Tranexamic acid: 500 mg was administered once a day for 3 days) and blood transfusions. By heart team it was decided to reduce antithrombotic therapy: antiplatelets were discontinued and her INR level was maintained 1.4-1.8. For 2 years prior to HTx LVAD function kept fine on minimized antithrombotic therapy without thromboembolic complications. It was made a multidisciplinary team decision to avoid combined oral contraceptives due to the high risk of thromboembolic complications outweighing the benefits. Twice she underwent urgent laparoscopic surgeries but after all her fertile function remained preserved. Conclusions: LVAD patients should be managed with a multidisciplinary heart team. In case of recurrent bleeding and low-risk of thromboembolic complications reduction of antithrombotic therapy should be considered. A personalized approach is essential to determine whether conservative or surgical management is superior, as it balances evidence-based medicine with individual patient needs, reducing the risks of futile or overly aggressive care. Taking into account the reproductive function, an organ-preserving operation was performed for the subsequent preservation of fertile function. Surgical interventions for gynecological disorders can be safely performed in patients “bridged” with LVAD.
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Simonenko et al. (2026) conducted a case report in Abnormal uterine bleeding following LVAD implantation for dilated cardiomyopathy and chronic heart failure with reduced ejection fraction (n=1). Minimized antithrombotic therapy (antiplatelets discontinued, target INR 1.4-1.8), tranexamic acid, blood transfusions, and urgent laparoscopic surgeries was evaluated on Thromboembolic complications, LVAD function, and preservation of fertile function. Minimized antithrombotic therapy (INR 1.4-1.8 without antiplatelets) and organ-preserving surgeries safely managed abnormal uterine bleeding for 2 years in a 15-year-old LVAD patient.
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