Bleeding and thrombotic events during micro-axial flow pump support: A European multicenter cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Bleeding and thrombosis are major complications of micro-axial flow pump (mAFP) support in cardiogenic shock (CS), yet contemporary data on their incidence, temporal trends, and prognostic impact remain unclear. METHODS: We retrospectively analyzed patients supported with mAFP between 2010 and 2023 across eleven high-volume European centers. Bleeding and thrombotic events during support were adjudicated and normalized to annual implant volumes. Kaplan–Meier analysis assessed 180-day survival, and multivariable logistic regression identified independent predictors of bleeding and thrombosis. RESULTS: Among 1,043 patients (61% acute myocardial infarction related CS), Impella CP was used in 72% and Impella 5 in 28%. Overall, 503 patients (48%) experienced ≥ 1 event: 252 bleeding only, 149 thrombosis only, and 102 both. Independent predictors of bleeding were post-cardiotomy CS (OR 2.64; 95% CI, 1.41–4.96; p = .003), Acute myocardial infarction related CS (AMICS) (OR 2.27; 95% CI, 1.38–3.74; p = .001), V-A ECMO unloading indication (OR 1.65; 95% CI, 1.14–2.39; p = .008) and renal replacement therapy at implantation (OR 1.56; 95% CI, 1.08–2.27; P = .019). Predictors of thrombosis were prior stroke (OR 2.51; 95% CI 1.40–4.51), AMI-CS (OR 2.06; 95% CI 1.42–3.00), and mAFP unloading with V-A ECMO (OR 2.03; 95% CI 1.38–2.98). Bleeding (OR 1.38; 95% CI 1.02–1.87) and thrombosis (OR 2.10; 95% CI 1.53–2.88) were independently associated with higher 180-day mortality. CONCLUSIONS: In this large European mAFP cohort, bleeding and thrombotic events were frequent and associated with mortality and adverse outcomes. Their distinct risk profiles support individualized prevention strategies and underscore the need for prospective randomized trials comparing anticoagulation regimens in risk-stratified patients.
Source: Critical Care
Authors: Aurore Ughetto, Benedikt Schrage, Christophe Vandenbriele, Miloud Cherbi, Antoine Beurton, Monika Fürholz, Wiktor Kuliczkowski, Laurent Bonello, Guillaume Leurent, Ana Hurtado, Philippe Gaudard, Jonas Sundermeyer, Lukas Hunziker, Alexandre Ouattara, Agnieszka Tycinska, Marta Zaleska Kociecka, Hadrien Pichené, Leo Lemarchand, Matias Jacomet, Mikolaj Blaziak, Aneta Klotzka, Alexandre Mansour, Clément Delmas, the IMPACT Investigators, Emma Chelvi Sendin, Arthur Chouaiki-perrois, Frederic Bouisset, Chloe Tassain, Fanny Vardon, Julien Imbault, Marie De Cuniac, François-Xavier Herion, Flecher Erwan, Nicolas Nesseler, Macarena Otero Escudero, Sara Gonzalez Lastra, Vasileios Panoulas, Benedikt Beer, Dettling Angela, Anna Konopka
Institutions: Centre National de la Recherche Scientifique, Inserm, Université de Montpellier, Physiologie et Médecine Expérimentale du Coeur et des Muscles, Centre Hospitalier Universitaire de Montpellier, Hôpital Arnaud de Villeneuve, Universität Hamburg, University Medical Center Hamburg-Eppendorf, German Centre for Cardiovascular Research, Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, Imperial College London, Hôpital Rangueil, Université de Bordeaux, Centre Hospitalier Universitaire de Bordeaux, Biologie des maladies cardiovasculaires, University Hospital of Bern, Wroclaw Medical University, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Laboratoire Traitement du Signal et de l'Image, Centre Hospitalier Universitaire de Rennes, Université de Rennes, Royal Brompton & Harefield NHS Foundation Trust, Medical University of Białystok, Institute of Cardiology, Poznan University of Medical Sciences, Institut de Recherche en Santé, Environnement et Travail, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Toulouse
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: gold
Estimated APC paid: $4,190
OpenAlex ID: W7154059210