Bleeding and thrombosis in patients with continuous-flow ventricular assist devices.

Because of the obligate intravascular location of contemporary continuous-flow ventricular assist devices (CFVADs), it is not surprising that bleeding and thrombosis are among the most common and feared complications of this therapy, respectively. Although strides have been made in our understanding of the pathophysiology of continuous flow, intravascular CF-VADs have been widely used only in the last few years, and a great deal remains less well known (or unknown). Outcomes have improved significantly over the past decade, but a deeper understanding of how these devices perturb the delicate intrinsic balance of bleeding and thrombosis is critical to guide therapy and to overcome the current obstacles to achieving a long-term safety profile comparable to that of mechanical prosthetic valves.