The left ventricular assist device (LVAD) is indicated as bridging or destination therapy in patients with advanced heart failure (HF) despite optimal medical therapy. The amount of LVAD implantations has augmented in recent years, which has led to recognition of an increased incidence of ischemic (IS) and hemorrhagic strokes (HS) in these patients. Today, there is paucity of data about the risk factors associated with the incidence of cerebrovascular complications in this particular population.

A total of 32 out of 192 patients with 1st and 2nd generation of LVAD were retrospectively found to have a cerebrovascular event between 2014-2018. Relevant clinical data and risk factors were collected. We used logistic regression to calculate odds ratio. Statistical tests were t-test for parametric variables; Mann-Whitney U test for continues nonparametric variables and Chi-square and Fisher test for proportions.

A total of 32 out of 192 LVAD patients suffered cerebrovascular complications (Incidence=16.6%); 59.38% had an IS and 40.63% had a HS. The patients with HS, were significantly younger than IS (50.08±12.93 vs 61.37±10.17, p=0.0097). There were no significant differences between the groups for type of LVAD, gender, race, coagulopathy, MAP, infection, or presence of LVAD thrombosis. However, the NIHSS was slightly higher in the HS group. After a LVAD implantation the odds of having a HS are negatively significant associated with age (OR .912, 95% CI .84-.99), and positively with INR > 2.5 (OR 1.63, 95% CI 1.02-2.60). In this univariate analysis, antiplatelet therapy and septicemia were marginally significant. On multiple logistic regression analysis, while age was negatively associated with a HS, INR and antiplatelet therapy were positively associated (area under the curve of the model for predicting a good outcome; overall probability of being correct = 0.9316, Pseudo R-square=0.53). While the small sample size limits our study, the Hosmer and Lemeshow statistic test indicated that the goodness of the fit of the model to the data was adequate (p = 0.81).

We were unable to identify clear risk factors for the development of IS in this population. However, young age, high INR and use of antiplatelet therapy were associated with a significantly increased incidence of hemorrhagic complications.