COVID-19 in LVAD Patients Not Associated with Increased Risk of Thrombotic Complications: A Single-Center Experience

PURPOSE: The COVID-19 pandemic continues to afflict millions worldwide. Scientific knowledge about the virus is expanding including the thrombosis risk associated with COVID-19 infection. However, this data in end-stage heart failure patients requiring mechanical circulatory support is limited. Thus we examined the incidence of thrombotic complications in COVID-19 infected LVAD patients. METHODS: We identified durable LVAD patients infected with COVID-19 from January 2020 to July 2021. We examined anticoagulation regimens and laboratory monitoring parameters that were used. Evidence of thromboembolic phenomena including stroke, venous or arterial and pump thrombosis were evaluated by clinical, radiographic and laboratory assessment. RESULTS: Of the 146 LVAD patients followed at our institution, 21 (14%) were infected with COVID-19. Median age was 69 years (IQR 58-73), 18 (86%) were men and 12 (57%) had non-ischemic cardiomyopathy. In our cohort, 3 (14%) had HeartWare VAD, 9 (43%) HeartMate 2 LVAD and 9 (43%) HeartMate 3 LVAD. Eighteen (86%) were on warfarin with a median international normalized ratio (INR) of 2 (IQR 1.6-2.9) at the time of COVID-19 diagnosis. Reasons for holding antithrombotic therapy included a history of gastrointestinal and intracranial hemorrhage. Fourteen (66.7%) patients required admission for COVID-19 infection. Two (14%) were not on anticoagulation and had an INR of 1.1 and 1.6 on admission. Patients on anticoagulation had a median INR of 2.4 (IQR 1.9-2.7) during hospitalization. Notably, there was no clinical, radiographic or laboratory evidence of thrombotic complications, including stroke, pump thrombosis, DVT, or arterial thrombosis. Two (10%) patients died due to septic shock and hypoxic respiratory failure resulting in cardiopulmonary arrest. CONCLUSION: Although COVID-19 is associated with increased thrombogenicity, there was no evidence of thrombosis in our 21 LVAD patients. Regardless of the patients’ anticoagulation status or INR, patients did not experience thrombotic events despite a theoretically heightened risk during acute COVID-19 infection.