Safety of Traditionally Dosed Enoxaparin in Patients Supported with Left Ventricular Assist Devices

Sloan, Brandon; Straw, L.B.; Mardis, Caitlin R.; Martin, Jfv; Napier, Rebecca; McCann, Patrick J.; Mardis, A.

doi:10.1016/j.healun.2020.01.834

Cited by 1 publication

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, only one center compared outcomes based on device type. 9 Sloan, et al compared bleeding episodes between HM II, HVAD and HM 3 recipients and found no difference in the incidence of bleeding events; however the number of bleeding episodes was overall lower than other centers. 9 In our analysis, we observed greater bleeding episodes in patients with a HM II device compared to those with an HVAD device.…”

Section: Discussionmentioning

confidence: 99%

“…9 Sloan, et al compared bleeding episodes between HM II, HVAD and HM 3 recipients and found no difference in the incidence of bleeding events; however the number of bleeding episodes was overall lower than other centers. 9 In our analysis, we observed greater bleeding episodes in patients with a HM II device compared to those with an HVAD device. The predominant site of bleeding was the gastrointestinal (GI) tract and occurred a median of 5 days from the initiation of enoxaparin “bridge” anticoagulation despite a lack of supratherapeutic INR at the time of the bleeding event.…”

Section: Discussionmentioning

confidence: 99%

“…Given the paucity of data evaluating management of a subtherapeutic INR in patients with LVADs, several centers have evaluated their site-specific practices, with varying results in the incidence of bleeding with enoxaparin “bridge” therapy. 8 -11,20 All of these centers reported a mixed population of LVADs implanted. However, only one center compared outcomes based on device type.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, other centers, with a mix of HMII and HVAD devices, using a similar strategy have not consistently demonstrated an increased bleeding risk with “bridge” therapy. 9 -11 In one small report, clinical outcomes compared between HMII and HVAD found no difference in bleeding. 9 Given the limited data evaluating the safety and efficacy of “bridge” therapy in LVAD patients, we aimed to evaluate our device-specific enoxaparin “bridge” protocol in HM II and HVAD recipients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of Outcomes of Enoxaparin Bridge Therapy in HeartMate II versus HeartWare HVAD Recipients

Patel

Ahuja

Arnouk

et al. 2021

J Cardiovasc Pharmacol Ther

View full text Add to dashboard Cite

Background: There is a lack of robust data evaluating outcomes of enoxaparin “bridge” therapy in left ventricular assist device (LVAD) patients. Methods: We performed a retrospective study of HeartMate II (HM II) and HeartWare HVAD recipients that received therapeutic enoxaparin as “bridge” therapy to describe bleeding and thrombotic events and compare outcomes between devices. The primary endpoint was the incidence of bleeding within 30 days of “bridge” episode. Major bleeding was defined by INTERMACS criteria. Results: We evaluated 257 “bridge” episodes in 54 patients, 35 with a HM II device and 19 with an HVAD device that underwent 176 and 81 bridging episodes, respectively. The median INR prior to “bridge” was lower in the HM II group compared to the HVAD group (1.5 vs 1.7, P < .01), however, there was no difference in the median duration of “bridge” therapy (7 vs 7 days, P = .42). There were a total of 30 (12%) bleeding episodes, with the majority in the HM II group vs HVAD (26 [15%] vs 4 [5%], P = .02). We observed 3 (1%) thromboembolic events in 2 (4%) patients with an HVAD device. On multivariate analysis, the presence of a HM II device was associated with a 4-fold increased risk of bleeding. Conclusion: We found the use of enoxaparin “bridge” therapy to be associated with a higher incidence of bleeding in patients with a HM II device compared with an HVAD device. Assessment of device- and patient-specific factors should be evaluated to minimize bleeding events.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%