Increased Thromboembolic Events With Dabigatran Compared With Vitamin K Antagonism in Left Ventricular Assist Device Patients

Andreas, Martin; Moayedifar, R.; Wieselthaler, Georg; Wolzt, Michael; Riebandt, Julia; Haberl, T.; Angleitner, Philipp; Schlöglhofer, Thomas; Wiedemann, Dominik; Schima, Heinrich; Laufer, Guenther; Zimpfer, Daniel

doi:10.1161/circheartfailure.116.003709

Cited by 78 publications

(55 citation statements)

References 29 publications

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“…There are insufficient dosing and safety data for their use in children. Of note, DOACs have failed in trials of artificial valves [256] and circuits [257], so their effectiveness in the setting of graft material (such as that used in extracardiac Fontan surgery) remains to be proven.…”

Section: Thromboprophylaxismentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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The Fontan circulation describes the circulatory state resulting from an operation in congenital heart disease where systemic venous return is directed to the lungs without an intervening active pumping chamber. As survival increases, so too does recognition of the potential health challenges. This document aims to allow clinicians, people with a Fontan circulation, and their families to benefit from consensus agreement about management of the person with a Fontan circulation. The document was crafted with input from a multidisciplinary group of health care providers as well as individuals with a Fontan circulation and families. It is hoped that the shared common vision of long-term wellbeing will continue to drive improvements in care and quality of life in this patient population and eventually translate into improved survival.

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Section: Thromboprophylaxismentioning

confidence: 99%

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Zentner

Celermajer

Gentles

et al. 2020

Heart, Lung and Circulation

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“…Antithrombotics are the cornerstone therapy in the outpatient management of LVAD. In addition to aspirin, warfarin is the anticoagulant of choice, while direct thrombin inhibitors (e.g., dabigatran) have failed to ascertain their usefulness in these patients [36]. Dabigatran was studied in a prospective randomized study in which 30 patients were randomized to either dabigatran or phenprocoumon (vitamin K antagonist).…”

Section: Managementmentioning

confidence: 99%

“…Dabigatran was studied in a prospective randomized study in which 30 patients were randomized to either dabigatran or phenprocoumon (vitamin K antagonist). This trial was prematurely discontinued due to the increased thromboembolic phenomenon observed in half of the patients (four out of eight) receiving dabigatran [36]. On warfarin therapy, the target INR is 2.0 -3.0 in LVAD patients [30].…”

Section: Managementmentioning

confidence: 99%

Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD)

Ahsan¹,

Faraz²,

Mehmood³

et al. 2019

Cureus

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Left ventricular assist devices (LVADs) are an exceedingly important form of mechanical support for patients with end-stage heart failure. LVADs can be utilized both as a bridge to cardiac transplant and also as a definitive treatment. However, a few complications are associated with LVAD placement, the most common and cumbersome of which is gastrointestinal (GI) bleeding with an incidence of about 30%. These bleeding events often require transfusion therapy, but they are rarely fatal. The etiologies of GI bleeding following LVAD are multifactorial and include unstable hemodynamics, an acquired von Willebrand factor (vWf) deficiency, impaired platelet aggregation, and activation of fibrinolytic systems. The treatment of choice in LVAD implantation-associated GI bleeding is endoscopy, which plays a vital role in both its diagnosis and management. Even so, its effectiveness in controlling post-LVAD implantation GI bleeding is still poorly ascertained. In this article, we will review the use of medication and alterations in the LVAD setting to prevent the occurrence of GI bleeding, as well as the findings of previously reported literature on LVAD implantation-associated GI bleeding.

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“…A small study of 7 patients using dabigatran showed no excess rate of bleeding or thrombosis . However, a single‐center, randomized trial of dabigatran vs. warfarin was terminated early due to increased thromboembolic events associated with dabigatran . Furthermore, given the negative experience with dabigatran use in mechanical heart valves, routine use cannot be recommended until ongoing clinical trials are completed.…”

Section: Management Strategiesmentioning

confidence: 99%

Hemostatic complications associated with ventricular assist devices

Hilal

Mudd

DeLoughery

2019

Research and Practice in Thrombosis and Haemostasis

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Hemostatic complications are common in patients with ventricular assist devices. The pathophysiologic mechanisms that lead to dysregulated hemostasis involve complex interactions between device surface, sheer stress, and blood flow. These factors lead to various manifestations that require a thorough understanding of the interplay among platelets, coagulation factors, and red cells. In this article, we review the pathophysiology of hematologic complications (bleeding, acquired von Willebrand disease, heparin‐induced thrombocytopenia, hemolysis, stroke and pump thrombosis), the clinical manifestations, and the management of each. We summarize the evidence available for management of these entities and provide a pragmatic clinical review.

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Increased Thromboembolic Events With Dabigatran Compared With Vitamin K Antagonism in Left Ventricular Assist Device Patients

Abstract: Supplemental Digital Content is available in the text.

Cited by 78 publications

References 29 publications

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD)

Hemostatic complications associated with ventricular assist devices

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