PB0989 - Performance of Risk Scores in Predicting Major Bleeding in LVAD Recipients

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Sabine F.B van der Horst, MD

Leiden University Medical Center, department of Thrombosis and Hemostasis
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

Yd

Ype de Jong

MD, PhD-student
Leiden University Medical Center, department of Thrombosis and Hemostasis and Clinical Epidemiology
Leiden, Zuid-Holland, Netherlands
Nienke van Rein

PhD
Leiden University Medical Center, department of Clinical Pharmacy and Toxicology and Clinical Epidemiology
Leiden, Zuid-Holland, Netherlands
JJ

J Wouter Jukema

MD, PhD, prof, FESC, FACC
Leiden University Medical Center, department of Cardiology
Leiden, Zuid-Holland, Netherlands
MP

Meindert Palmen

MD, PhD
Leiden University Medical Center, department of Thoracic surgery
Leiden, Zuid-Holland, Netherlands
EJ

Eva Janssen

MD
Leiden University Medical Center, department of Cardiology
Leiden, Zuid-Holland, Netherlands
EB

Edouard F. Bonneville

PhD-student
Leiden University Medical Center, department of Biomedical Data Sciences
Leiden, Zuid-Holland, Netherlands
Erik Klok, MD, PhD, FESC

Leiden University Medical Center
MH

Menno V. Huisman

Professor of Medicine
Department of Medicine – Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Dutch Thrombosis Network, The Netherlands.
Leiden, Zuid-Holland, Netherlands
LT

Laurens F. Tops

MD, PhD
Leiden University Medical Center, department of Cardiology
Leiden, Zuid-Holland, Netherlands
Pd

Paul L. den Exter

Hematologist
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands

Background: Implantation of a left ventricular assist device (LVAD) is a crucial therapeutic option for selected end-stage heart failure patients. However, major bleeding (MB) complications post-implantation are a significant concern.

Aims: We aimed to evaluate and compare the performance of seven current bleeding risk scores in predicting MB in post-LVAD implantation. The selected risk scores include HAS-BLED, HEMORR2HAGES, Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA), VTE-BLEED, AF-BLEED, Outpatient Bleeding Risk Index (OBRI), and Utah Bleeding Risk Score (UBRS).

Methods: We conducted an observational, single-center study of LVAD recipients (HeartWare or HeartMate-3, November 2010 - December 2022) in the Netherlands. The primary outcome was the time to first post-LVAD MB, according to ISTH, INTERMACS and INTERMACS combined with intracranial bleeding (INTERMACS+) criteria. Mortality prior to MB was considered a competing event. Discrimination (C-statistic) and calibration were evaluated for each risk score.

Results: 103 patients were included (median age: 64 years (Q1 – Q3: 58 – 68), female: 20.4%, HeartWare: 90.3%). The cumulative MB incidence was 75.8% (95%CI 65.6–85.9%) per ISTH and INTERMACS+ criteria, and 67.1% (56.1–78.0%) per INTERMACS criteria, over a median event-free follow-up time of 1916 days (range: 131 – 4521 days). All scores had poor discriminative ability on their intended prediction timeframe. C-statistics ranged between 0.49 (95%CI 0.35 – 0.63, VTE-BLEED) and 0.56 (95%CI 0.47 – 0.65, UBRS) according to ISTH and INTERMACS+, and between 0.48 (95%CI 0.40 – 0.56, ATRIA) and 0.56 (95%CI 0.47 – 0.65, UBRS) per INTERMACS criteria. All models showed poor calibration, largely underestimating MB risk.

Conclusion(s): Current bleeding risk scores exhibit inadequate predictive accuracy for LVAD recipients. There is a need for an accurate risk score to identify LVAD patients at high risk of MB who may benefit from patient-tailored anti-thrombotic therapy.