Long-Term Withdrawal of Anticoagulation and Antiplatelet Therapy in a HeartMate 3 Left Ventricular Assist Device

Menchaca, Kristina; Perez, Catherine A Ostos; Draguljevic, Nemanja; Paciletti, Jennifer; Ghumman, Waqas; Faber, Cristiano; Mirza, Sajid

doi:10.7759/cureus.28779

Cited by 3 publications

(2 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results have been confirmed in the PREVENTII trial 8 . Moreover, the MOMENTUM 3 trial demonstrated that usual and low aspirin doses had same rates of bleeding and thrombotic events after HM3 implantation 9 and some reports illustrate the absence of thrombotic events in patients without antiplatelet therapy 10,11 . In patients supported by A-TAH, we previously described a decrease in platelet activation evaluated with platelet microvesicles in three patients implanted with A-TAH compared to a HM2 cohort 12 .…”

Section: Introductionmentioning

confidence: 99%

Platelet activation with the Aeson Bioprosthetic Total Artificial Heart: insight from aspirin treatment and outcomes

Smadja

Peronino

Jilet

et al. 2023

Preprint

View full text Add to dashboard Cite

Introduction: The Aeson bioprosthetic total artificial heart (ATAH) is a pulsatile and autoregulated device. The aim of this study was to evaluate the level of platelet activation secondary to ATAH implantation. Methods: We examined the level of platelet activation markers in adult patients receiving ATAH support (n=16) during clinical follow up by quantifying sPselectin (sPsel) and sCD40L in plasma. Results: The cumulative duration of ATAH support was 3587 days. Before implantation, sCD40L was 2684.6 pg/mL (954.0;16706.1) and remained steady after implantation [3305.8 pg/mL (1234.2;12327.5), 3300.5 pg/mL (1041.5;8370.1), and 2560.0 pg/mL (1325.5;14039.5), respectively, at <3 months, 3/6 months and >6 months; non-significant difference along time-period]. sPsel was 33997.0 pg/mL (16019.6;73377.6) and remained steady after implantation [33580.1 pg/mL (13979.8;53395.2), 33204.9 pg/mL (15332.6;67263.4), and 34684.5 pg/mL (14084.9;49206.0), respectively, at <3 months, 3/6 months and >6 months; non-significant difference along time-period]. Levels sPsel and sCD40L analysed according to aspirin or heparin use did not change. Finally, no relation existed between pericardial effusion and aspirin use according to timing of aspirin start and drain removal. Conclusions: We demonstrated that ATAH does not induce significant platelet activation. Absence of relationship between aspirin and platelet activation levels or pericardial effusion may support potential for withdrawal of antiplatelet therapy after ATAH implantation in the future.

show abstract

Section: Introductionmentioning

confidence: 99%

Platelet activation with the Aeson Bioprosthetic Total Artificial Heart: insight from aspirin treatment and outcomes

Smadja

Peronino

Jilet

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The HM3 replaces the work of the left ventricle. It is a magnetically levitated centrifugal-flow pump at the level of the apex of the left ventricle (outside of the pericardium) and, through a 20 mm inflow conduit inside the ventricle, translates about 3–6 L of blood per minute in resting conditions, with a constant flow [ 3 , 4 ]. The pump structure has been designed to reduce the risk of thrombotic formation.…”

Section: Introductionmentioning

confidence: 99%

Hyoid Bone Syndrome in a Patient Undergoing Left Ventricular Assist Device Implantation

Bordoni

Escher

2023

Healthcare

View full text Add to dashboard Cite

The clinical case describes the presence of hyoid bone syndrome (HBS) in a patient with a left ventricular assist device (LVAD) implantation, and the resolution of painful symptoms through an osteopathic manual technique (unwinding) applied to the tongue. To the knowledge of the authors, it is the first case report involving an LVAD patient with HBS treated with an osteopathic approach. The article briefly reviews the data relating to surgical therapy for patients with a clinical history of end-stage heart failure and symptoms related to HBS and posits some hypotheses on the presence of pain radiating from the hyoid bone to other areas of the body. The text reminds us to place greater clinical emphasis on the palpatory evaluation of the hyoid in the presence of non-specific painful symptoms.

show abstract

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

View full text Add to dashboard Cite

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.

show abstract

Long-Term Withdrawal of Anticoagulation and Antiplatelet Therapy in a HeartMate 3 Left Ventricular Assist Device

Cited by 3 publications

References 6 publications

Platelet activation with the Aeson Bioprosthetic Total Artificial Heart: insight from aspirin treatment and outcomes

Platelet activation with the Aeson Bioprosthetic Total Artificial Heart: insight from aspirin treatment and outcomes

Hyoid Bone Syndrome in a Patient Undergoing Left Ventricular Assist Device Implantation

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

Contact Info

Product

Resources

About