Antithrombotic therapy for durable left ventricular assist devices — current strategies and future directions

Weingarten, Noah; Song, Cindy; Iyengar, Amit; Herbst, D. Alan; Helmers, Mark R.; Meldrum, D.; Guevara-Plunkett, Sara; Dominic, J.; Atluri, Pavan

doi:10.1007/s12055-022-01409-z

Cited by 2 publications

(1 citation statement)

References 55 publications

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“…Close monitoring and optimization of the functional status prior to surgery is necessary in this vulnerable population. Patients with prior ischemic stroke who are on anticoagulants, including warfarin and heparin, have increased perioperative considerations in regards to when to withhold and restart antithrombotic agents, balancing the necessity of thromboprophylaxis with increased bleeding risk [22,23]. In the postoperative period, effective anticoagulation in combination with subsequent stroke prevention and a close monitoring of functional status are crucial for patients with a history of stroke prior to implant [24].…”

Section: History Of Stroke and Hypercoagulabilitymentioning

confidence: 99%

Special Considerations for Advanced Heart Failure Surgeries: Durable Left Ventricular Devices and Heart Transplantation

Akbar,

Zhou,

Wang

et al. 2024

JCDD

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Heart transplantation and durable left ventricular assist devices (LVADs) represent two definitive therapies for end-stage heart failure in the modern era. Despite technological advances, both treatment modalities continue to experience unique risks that impact surgical and perioperative decision-making. Here, we review special populations and factors that impact risk in LVAD and heart transplant surgery and examine critical decisions in the management of these patients. As both heart transplantation and the use of durable LVADs as destination therapy continue to increase, these considerations will be of increasing relevance in managing advanced heart failure and improving outcomes.

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Section: History Of Stroke and Hypercoagulabilitymentioning

confidence: 99%

Special Considerations for Advanced Heart Failure Surgeries: Durable Left Ventricular Devices and Heart Transplantation

Akbar,

Zhou,

Wang

et al. 2024

JCDD

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Retrospective Evaluation of Inpatient Warfarin Management Practices in Patients Immediately Following Left Ventricular Assist Device Implantation

Feih,

Weierstahl,

Juul

et al. 2024

Journal of Pharmacy Technology

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Background: The International Society for Heart and Lung Transplantation recommends patients receive warfarin and aspirin following left ventricular assist device (LVAD) placement. Optimal warfarin management in this population has not been well established. Objectives: The objectives of this study were to evaluate warfarin practices in patients immediately post-LVAD implantation. Methods: This single-center, retrospective cohort study included patients 18 years and older following LVAD placement from August 1, 2012 to April 1, 2020. The primary outcome was to assess patient-specific risk factors affecting time to therapeutic range. Secondary outcomes included bleeding events, thrombotic events, and warfarin dosing patterns. Results: Of 104 included patients, 91% reached the therapeutic range at a median of 8 days. A higher proportion of patients started on 3.5 mg or higher reached therapeutic international normalized ratio (INR) and faster (96% vs 90%; 8 vs 5 days) compared to lower doses. Univariate analysis of associations with reaching therapeutic INR range included initial warfarin dose, cumulative warfarin, and warfarin dosing changes, whereas HAS-BLED and CHA2DS2VAC were associated with slower time to therapeutic INR. Overall, 44% of patients met Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) bleeding criteria. There were a total of 12 thrombotic events and no pump thrombotic events. Total weekly warfarin dosing was significantly lower post-LVAD (24.3 mg vs 35 mg, P = 0.0009). In addition, warfarin requirements were statistically higher after the first week of therapy (4.0 mg vs 2.89 mg, P < 0.0001). Conclusion: Based on the results, consider warfarin starting dose between 2.5 and 4 mg for patients on LVAD therapy, while balancing patient-specific risks for bleeding.

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Antithrombotic therapy for durable left ventricular assist devices — current strategies and future directions

Cited by 2 publications

References 55 publications

Special Considerations for Advanced Heart Failure Surgeries: Durable Left Ventricular Devices and Heart Transplantation

Special Considerations for Advanced Heart Failure Surgeries: Durable Left Ventricular Devices and Heart Transplantation

Retrospective Evaluation of Inpatient Warfarin Management Practices in Patients Immediately Following Left Ventricular Assist Device Implantation

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