Low-molecular-weight heparin for anti-coagulation after left ventricular assist device implantation

Sandner, Sigrid; Riebandt, Julia; Haberl, T.; Mahr, Stéphane; Rajek, Angela; Schima, Heinrich; Wieselthaler, G.; Laufer, Guenther; Zimpfer, Daniel

doi:10.1016/j.healun.2013.10.009

Cited by 38 publications

(32 citation statements)

References 32 publications

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“…We also found that nearly one quarter of patients used enoxaparin in the year after LVAD. While no guidelines exist to support its use after LVAD, it has been shown to have biologic efficacy in the LVAD population . Although there has been interest in understanding whether it is safe to use novel oral anticoagulants as an alternative to warfarin post‐LVAD implantation, we saw no evidence of their use in our study.…”

Section: Discussionmentioning

confidence: 72%

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Tan

Sangaralingham

Schilz

et al. 2017

JAHA

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BackgroundThere are few data describing the longitudinal use of and adherence to heart failure medications following left ventricular assist device (LVAD) implantation.Methods and ResultsUsing a large US commercial insurance database, patients who received an LVAD (International Classification of Diseases, 9th Revision, Clinical Modification code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1‐year post‐LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post‐LVAD medication use and poor medication adherence (proportion of days covered <0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and loop diuretics did not change. Pre‐LVAD medication use was associated with post‐LVAD use across all medication classes. The proportion of patients with poor medication adherence was 28.8%, 39.0%, and 36.0% for β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and anticoagulants, respectively. Many patients with poor adherence completely discontinued use of the medication.ConclusionsNeurohormonal antagonist use after LVAD was inconsistent, perhaps reflecting uncertainty of therapeutic benefit in this population. Medication adherence post‐LVAD was poor in many patients. Further work is needed to delineate the reasons for nonadherence after LVAD.

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Section: Discussionmentioning

confidence: 72%

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Tan

Sangaralingham

Schilz

et al. 2017

JAHA

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“…Retrospective cohort studies comprised 58% (14/24) of the included studies (Table 1) [21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Nine prospective cohort studies [15,[35][36][37][38][39][40][41][42] and a retrospective analysis of a randomized trial [43] were also included. Almost all of the studies did not include a comparison group and thus were deemed of moderate quality.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with cardiogenic shock or decompensated heart failure with progressive decline (INTERMACS level 1 or 2) comprised 46% (404/808) of patients with a 19% overall mortality [15,26,27,39,42]. Cause of death was reported in 11 studies [15,26,27,31,35,[37][38][39]41,42]. Multi-organ failure was the most frequent cause of death in 31% of patients (56/ 178).…”

Section: Resultsmentioning

confidence: 99%

“…Mechanical issues of different LVADs have a major impact on thrombus formation inside the devices. Sus- 1/57 (2) 2/57 (4) 3/57 (5) 8/57 (14) Stern [32] ASA + (2) Bishop [21] ASA, C (n 14/55 (25) Hayes [23] ASA + C pected pump thrombosis occurred in 6/13 of the first HVAD Ò patients in Europe, which was attributed to alterations in the bearing system of the impeller [41]. The inflow cannula of the HVAD Ò device was originally designed with smooth titanium, but an eccentric growth of tissue around the cannula was found in explanted hearts at transplant.…”

Section: Discussionmentioning

confidence: 99%

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Antithrombotic therapy for left ventricular assist devices in adults: a systematic review

Kreuziger

Kim

Wieselthaler

2015

Journal of Thrombosis and Haemostasis

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Summary Background Left ventricular assist devices (LVADs) have dramatically increased the survival of adults with end‐stage systolic heart failure. However, rates of bleeding and thromboembolism remain high. Objectives We completed a systematic review to evaluate outcomes of adults with LVADs treated with various anticoagulant and antiplatelet strategies. Methods Databases were searched using the terms ‘assist device’, ‘thrombosis’, and ‘anticoagulant’ or ‘platelet aggregation inhibitor’ with appropriate synonyms, device names and manufacturers. Results and Conclusions Of 977 manuscripts, 24 articles met the inclusion criteria of adults with implanted LVADs where clinical outcomes were defined based on anticoagulant and/or antiplatelet regimen. Most studies reported treatment with unfractionated heparin post‐operatively which was transitioned to a vitamin K antagonist (VKA). Goal INR varied between 1.5–3.5. Antiplatelet regimens ranged from no treatment to dual therapy. Definition of major bleeding differed between trials and incidence varied between 0% and 58%. The available evidence could not demonstrate a clear benefit of aspirin compared with VKA therapy alone [stroke RR 1.02 (95% CI 0.49–2.1)]. There was a suggestion that treatment with aspirin and dipyridamole decreased the risk of thromboembolism compared to aspirin [RR 0.50 (0.36–0.68)], but the comparison is limited by differences in demographics, devices, and INR goals among studies. Additionally, most studies did not blind investigators to outcomes thus contributing to an increased risk for bias. Clinical equipoise exists as to the most appropriate antithrombotic therapy in LVAD patients. Randomization between regimens within a prospective trial is needed to define the treatment regimen that minimizes both bleeding and thrombotic complications.

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“…17 Early postoperative anticoagulation therapy was initiated with low-molecular-weight heparin and changed to phenprocoumon thereafter. 18 Antithrombotic therapy was added with acetylsalicylic acid (200 mg/d) in accordance with the institutional protocol.…”

Section: Methodsmentioning

confidence: 99%

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

Andreas

Moayedifar

Wieselthaler

et al. 2017

Circ: Heart Failure

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Low-molecular-weight heparin for anti-coagulation after left ventricular assist device implantation

Cited by 38 publications

References 32 publications

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Antithrombotic therapy for left ventricular assist devices in adults: a systematic review

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

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