Anticoagulation alone as an effective and safe antithrombotic therapy in LVAD: When less is more

Tarzia, Vincenzo; Tessari, Chiara; Bagozzi, Lorenzo; Bottigliengo, Daniele; Fagan, Davide; Fabozzo, Assunta; Mastro, Florinda Rosaria; Pagnin, Chiara; Bottio, Tomaso; Gregori, Darío; Gerosa, Gino

doi:10.1016/j.cpcardiol.2022.101506

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…The Minimal AnticoaGulation EvaluatioNTo aUgment heMocompatibility (MAGENTUM 1) pilot trial ( n = 15, HeartMate-3) suggested that a low-intensity anticoagulation regimen (warfarin, target INR 1.5-1.9, with ASA) is safe with regard to thromboembolic outcomes within the first 6 months post-LVAD implantation [ 28 ]. Two observational studies ( n = 161 and n = 60, HeartMate-3) reported that reduced antithrombotic therapy (VKA-only, ASA-only, or no antithrombotic therapy at all) may reduce bleeding complications without increasing thromboembolic risk compared with standard anticoagulant care [ 29 , 30 ]. However, the prospective observational United States STudy of Reduced Anti-Coagulation/Anti-platelEt Therapy in Patients with the HeartMate II Left Ventricular Assist System (US-TRACE) ( n = 100, HeartMate-2) concluded that discontinuing ASA, VKA, or both may increase thromboembolic complications (incidence pump thrombosis 7%, ischemic stroke 6%) with persistent bleeding events (approximately 40% among the 3 treatment groups) at 1-year follow-up [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Performance of risk scores in predicting major bleeding in left ventricular assist device recipients: a comparative external validation

van der Horst,

de Jong,

van Rein

et al. 2024

Research and Practice in Thrombosis and Haemostasis

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Section: Discussionmentioning

confidence: 99%

Performance of risk scores in predicting major bleeding in left ventricular assist device recipients: a comparative external validation

van der Horst,

de Jong,

van Rein

et al. 2024

Research and Practice in Thrombosis and Haemostasis

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“…FIGURE 2: Comparing the risk of thrombotic events between the two groupsSources: References[10][11][12][13] …”

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confidence: 99%

Comparing the Efficacy and Safety of Warfarin Monotherapy vs. Warfarin and Aspirin for Adult Patients With Left Ventricular Assist Devices: A Meta-Analysis

Bandaru,

Rawat,

Jalali

et al. 2024

Cureus

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The aim of this meta-analysis was to assess the safety and efficacy of warfarin plus aspirin versus warfarin monotherapy in patients with left ventricular assist devices (LVAD). The present meta-analysis was conducted using the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two authors systematically searched online databases, including PubMed, EMBASE, the Cochrane Library, and Web of Science from inception to December 31, 2023. Outcomes assessed in this meta-analysis included any thrombotic event, bleeding events, and all-cause mortality. A total of five articles were included in the meta-analysis, enrolling a pooled sample size of 876 patients, including 405 in the warfarin monotherapy group and 471 in the warfarin plus aspirin group. Pooled analysis showed that the risk of thrombotic events was not significantly different between the two groups (risk ratio (RR): 0.46, 95% confidence interval (CI): 0.15-1.37). The risk of bleeding events was significantly lower in patients receiving warfarin alone compared to patients receiving aspirin plus warfarin (RR: 0.67, 95% CI: 0.53-0.85). The risk of all-cause mortality was not significantly different between patients receiving warfarin alone and patients receiving aspirin plus warfarin (RR: 0.92, 95% CI: 0.65-1.30). Despite the potential benefits of discontinuing aspirin, the decision should be approached cautiously, considering the undefined risks of discontinuing anticoagulation in LVAD patients.

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Omission of Antiplatelet Therapy in Patients With HeartMate 3 Left Ventricular Assist Devices: A Systematic Review and Meta-Analysis

Tscharre,

Mutschlechner,

Schlöglhofer

et al. 2024

ASAIO Journal

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The HeartMate 3 (HM3) left ventricular assist device has decreased thromboembolic events and minimized the risk of pump thrombosis. However, bleeding complications due to combined antithrombotic therapy with a vitamin K antagonist (VKA) and aspirin remain high. Only limited data on the safety of VKA monotherapy in HM3 patients are available. A systematic search on the main databases was performed. Observational data and randomized trials were eligible for this analysis. As primary endpoint, we analyzed hemocompatibility-related adverse events (HRAE). As secondary endpoints, we investigated the individual components of the primary endpoint. The analysis was carried out using the odds ratio (OR) as outcome measure. A random-effects model was fitted to the data. Five manuscripts fulfilled the inclusion criteria. These trials included 785 patients (381 on VKA monotherapy, 404 on VKA and aspirin). VKA monotherapy significantly reduced HRAE (OR: 0.11 [95% confidence interval {CI}: 0.02–0.59], p = 0.01, I 2 = 87%). The reduction was driven by a decrease in bleeding complications (OR: 0.12 [95% CI: 0.02–0.62], p = 0.01, I 2 = 86%) without increasing the rates of thromboembolic events (OR: 0.69 [95% CI: 0.26–1.81], p = 0.45, I = 0%). Vitamin K antagonist monotherapy is associated with a significant reduction of bleeding events without increasing the risk of thromboembolic complications in HM3 patients.

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Anticoagulation alone as an effective and safe antithrombotic therapy in LVAD: When less is more

Cited by 5 publications

References 23 publications

Performance of risk scores in predicting major bleeding in left ventricular assist device recipients: a comparative external validation

Performance of risk scores in predicting major bleeding in left ventricular assist device recipients: a comparative external validation

Comparing the Efficacy and Safety of Warfarin Monotherapy vs. Warfarin and Aspirin for Adult Patients With Left Ventricular Assist Devices: A Meta-Analysis

Omission of Antiplatelet Therapy in Patients With HeartMate 3 Left Ventricular Assist Devices: A Systematic Review and Meta-Analysis

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