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Andreas Koster, Nikolai Hulde, Vera von Dossow, Gabor Erdös

• \(\textbf {Purpose of This Review}\) The implantation of a left ventricular assist device (LVAD) is associated with high hemorrhage-related re-exploration rates. Improved management of coagulopathy may improve patient outcome. The optimal management of acquired coagulopathy in LVAD patients needing urgent non-cardiac surgery needs to be defined. We aim to review risk factors for perioperative bleeding and diagnosis and management of LVAD-associated coagulopathy and to provide expert recommendations for clinical practice. \(\textbf {Recent Findings}\) In patients undergoing LVAD implantation, the severity of coagulopathy is directly related to the severity of the cardiac failure. The evidence from current literature for optimal management of acquired coagulopathy during and after LVAD implantation is sparse. The traditional transfusion strategy of replacing coagulation factors with fresh frozen plasma involves the risk of transfusion-associated circulatory overload. Current recommendations for targeted replacement of coagulation factors with 4-factor prothrombin concentrate and fibrinogen concentrate in cardiac surgery may be translated in this special setting. \(\bf Summary\) The targeted, point-of-care use of concentrated coagulation factors may improve treatment of severe acquired coagulopathy during LVAD implantation and in LVAD patients needing urgent non-cardiac surgery.