Device-related epistaxis risk: continuous-flow left ventricular assist device-supported patients



The aim of this study was to analyze the effect of device-dependent factors on epistaxis episodes comparing patients supported with a continuous-flow left ventricular assist device (CF-LVAD) to patients under the same antithrombotic therapy.


Patients who underwent CF-LVAD between 2012 and 2018 were reviewed retrospectively from the institutionally adopted electronic database. Patients who underwent mitral valve replacement (MVR) surgery receiving the same anticoagulant and antiaggregant therapy were included as a control group. Demographics, epistaxis episodes, and nonepistaxis bleeding between the two groups were compared.


A total of 179 patients met the inclusion criteria (61 patients CF-LVAD group, 118 patients MVR group). The median (range) follow-up periods for the study (CF-LVAD) and control (MVR) groups were 370 (2819) and 545.70 (2356) days, respectively. There was a significant difference for frequency of bleeding episodes per month between CF-LVAD and MVR groups (p = 0.003 < 0.05). The most common site of bleeding was the anterior septum in both groups (90.9% for the CF-MVR group and 100% for the MVR group). While 14 patients (23%) had nonepistaxis bleeding in the CF-LVAD group, only two patients (1.7%) had nonepistaxis bleeding in the MVR group. There were significant differences in nonepistaxis bleeding rates between the CF-LVAD and MVR groups (χ2=19.79, p < 0.001).


Both epistaxis and nonepistaxis bleeding rates were higher in the CF-LVAD group than in the MVR group. This suggests that the use of CF-LVAD support could directly increase the risk of hemorrhagic complications.

Level of evidence

2A (Etiology/Harm)

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The authors would like to thank Wiley Editing Services for English language editing.


Any research fund did not support this study.

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Correspondence to Omer Vural.

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The authors declare that they have no conflict of interest.

Ethical approval:

This retrospective study was performed after approval of the Ethical Committee of the University Hospital (Baskent University Medical and Health Sciences Research Council and Ethics Committee, KA 19/90) and has been performed according to the ethical standards of the Helsinki Declaration.

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This was a retrospective data analysis study and it did not need informed consent.

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Koycu, A., Vural, O., Bahcecitapar, M. et al. Device-related epistaxis risk: continuous-flow left ventricular assist device-supported patients. Eur Arch Otorhinolaryngol (2020).

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  • Epistaxis
  • Left ventricular assist device
  • Anticoagulant therapy
  • Antiaggregant therapy
  • Von Willebrand factor
  • Mitral valve replacement
  • Spontaneous nontraumatic epistaxis
  • Nonepistaxis bleeding
  • Septum
  • Hemorrhagic complications