Low stroke rate and few thrombo-embolic events after HeartMate II implantation under mild anticoagulation

Menon, Ares Krishna; Götzenich, Andreas; Saßmannshausen, Helena; Haushofer, M; Autschbach, Rüdiger; Spillner, Jan

doi:10.1093/ejcts/ezr312

Cited by 47 publications

(24 citation statements)

References 11 publications

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“…(31, 32) Suggesting caution with a low target INR strategy, low PTTR (PTTR<50%) due to sub-therapeutic INRs with the 2.0–3.0 target was associated with substantially higher risk of thromboembolism in our cohort. This suggests tighter anticoagulation control may in general be a better strategy than lowering INR targets.…”

Section: Discussionmentioning

confidence: 83%

Anticoagulation Control in Patients With Ventricular Assist Devices

Boehme¹,

Pamboukian

George

et al. 2017

ASAIO Journal

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Anticoagulation control has been associated with risk of thromboembolism and hemorrhage. Herein, we explore the relationship between anticoagulation control achieved in Left Ventricular Assist Device Patients (LVADs) and evaluate the association with risk of thromboembolism and hemorrhage. Patients (aged 19 or older) with a continuous flow LVAD placed from 2006–2012. Proportion of time spent in target range (PTTR) for INR was estimated with target range of 2.0–3.0. PTTR was categorized into PTTR>60%, PTTR≥50<60% and PTTR<50%. The relationship between PTTR and thromboembolism and hemorrhage was assessed. The 115 participants contributed 624.5 months of follow-up time. Only 20% of patients achieved anticoagulation control (PTTR >60% for INR range of 2–3). After adjusting for chronic kidney disease, history of diabetes, history of atrial fibrillation and age at implant, compared to patients with PTTR<50%, the relative risk of thromboembolism in patients with PTTR≥60% (HR 0.37, 95%CI 0.14–0.96, p=0.042) was significantly lower, but not for patients with a PTTR of ≥50<60% (HR 0.21, 95%CI 0.02–1.82, p=0.16). The relative risk for hemorrhage was also significantly lower among patients with a PTTR≥60 % (HR 0.45, 95%CI 0.21–0.98, p=0.045), but not among those with PTTR of ≥50<60% (HR 0.47, 95%CI 0.14–1.56, p=0.22). This current study demonstrates that LVAD patients remain in the INR target range an average of 42.9% of the time. To our knowledge, this is the first report with regard to anticoagulation control as assessed by PTTR and its association with thromboembolism, hemorrhage or death among patients with VADs.

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Section: Discussionmentioning

confidence: 83%

Anticoagulation Control in Patients With Ventricular Assist Devices

Boehme¹,

Pamboukian

George

et al. 2017

ASAIO Journal

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“…During the perioperative period, up to 60% of patients experience excess bleeding, and historically 5%-20% have experienced thromboembolism or stroke (1 ). Although some newer continuous-flow LVAD devices demonstrate lower rates of systemic thromboembolism and bleeding, device thrombosis continues to be a problem (4 ). Hemorrhage and thromboembolism are also common long-term complications after device implantation (5 ).…”

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confidence: 99%

Precision and Reliability of 5 Platelet Function Tests in Healthy Volunteers and Donors on Daily Antiplatelet Agent Therapy

Karon¹,

Tolan

Koch³

et al. 2014

Clinical Chemistry

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“…In efforts to curtail major bleeding, milder forms of anticoagulation following LVAD implantation were performed, reporting comparable freedom from thromboembolic events with improved freedom from bleeding [18][19][20]. Stulak and colleagues [16], however, report that patients with gastrointestinal bleeding had significantly higher risk of thromboembolic events, partially explained by the reduction in anticoagulation during treatment of the gastrointestinal bleed.…”

Section: Key Pointsmentioning

confidence: 99%

Anticoagulation strategies for left ventricular assist devices

Toeg

Ruel²,

Haddad

2015

Current Opinion in Cardiology

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Recommendations for thromboprophylaxis in patients with LVADs are scarce. The International Society for Heart and Lung Transplantation has put together minimum criteria for perioperative anticoagulation; however, this is on the basis of poor level of evidence (observational studies and expert opinion). Ultimately, clinicians will need to individualize the intensity and timing of anticoagulation following LVAD implantation to ensure adequate thromboprophylaxis while simultaneously minimizing bleeding.

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Low stroke rate and few thrombo-embolic events after HeartMate II implantation under mild anticoagulation

Abstract: Compared with the literature, even a mild anticoagulation protocol does not increase the risk of thrombotic events, but reduces bleeding events in the use of an HM II LVAD.

Cited by 47 publications

References 11 publications

Anticoagulation Control in Patients With Ventricular Assist Devices

Anticoagulation Control in Patients With Ventricular Assist Devices

Precision and Reliability of 5 Platelet Function Tests in Healthy Volunteers and Donors on Daily Antiplatelet Agent Therapy

Anticoagulation strategies for left ventricular assist devices

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