A 59-year old female with anthracycline-associated DCM progressed to end stage heart failure and received an LVAD as a bridge to transplant. Three months s/p LVAD placement, she developed abdominal pain and bright red blood per rectum (BRBPR). On admission, she was anemic and had an INR of 2.4. She subsequently developed intracranial hemorrhage and goals of care were adjusted to comfort measures only. Testing at this time showed reduced vWF activity. The autopsy showed the following findings. What was the most likely cause of death?
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Acquired von Willebrand deficiency (vWD) in the setting of a ventricular assist device (VAD)
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