Abstract 10844: Black Race and Risk of Bleeding Events in Patients With Durable Left Ventricular Assist Devices

Introduction: An analysis from the MOMENTUM 3 trial showed that black patients have an increased risk of bleeding compared to white patients. We sought to examine racial differences in the risk of long term bleeding (up to 3 years) in patients with cf-LVADs using the INTERMACS database. Hypothesis: Black race is associated with an increased risk of bleeding events after cf-LVAD. Methods: We included 11,457 patients from the INTERMACS registry, who were implanted with primary CF-LVAD between 2012-2017. Using a cox proportional hazards model, we assessed the relationship between race and bleeding events up to 3 years post LVAD implantation after adjusting for covariates*. Analysis was started at 3 months post implantation to focus on long-term bleeding risk rather than early, post-operative bleeding. These bleeding events were stratified for the two major types of bleeding, GI bleeding (GIB) and intracranial hemorrhage (ICH). Results: This study included 2884 black patients (25.8%) and 8505 non-black patients (74.2%). Black patients tended to be younger (52.2 vs 58.6 yr p<0.001) with more women (30.9% vs 17.7% p<0.001) when compared to non-black patients. There were 1442 black patients who had a bleeding event vs 3972 non-black patients (50.0% vs 46.7% p=0.007) over 3 years of follow up (Fig 1). After adjusting for age, sex, and other covariates*, we found that black patients were more likely to have any bleeding event post LVAD implantation compared to non-black patients (adj HR 1.19 p<0.0001). When stratified by type of bleeding, the risk of ICH was similar between the two groups (10.8% vs 9.2%, adj HR 1.12, p 0.35), but the risk of GIB was higher among black vs non-black patients (30.9% vs 29.6%; adj HR 1.36, p<0.0001). Conclusions: Black patients have a higher risk of long term bleeding and specifically GIB after LVAD implantation. Further studies are warranted to elucidate this relationship and potential clinical implications including anticoagulation strategies.