Apixaban Anticoagulation in Children and Young Adults Supported With the HeartMate 3 Ventricular Assist Device

Cetatoiu, Maria A.; Kobayashi, Ryan; Esteso, Paul; Ventresco, Courtney; Hawkins, Beth; Daly, Kevin P.; Blume, Elizabeth D.; Fynn-Thompson, F.; VanderPluym, Christina

doi:10.1097/mat.0000000000001889

Cited by 10 publications

(3 citation statements)

References 11 publications

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“…While our center can receive same day results for apixaban levels, we do realize that is not an option at all institutions. The described prophylactic and therapeutic apixaban levels have been demonstrated to have appropriate efficacy, safety, and low events rates in an analysis 219 pediatric patients, along with five HM3 VAD patients, from our institution, 17,18 along with a large meta-analysis in adults. 19 It has been demonstrated that chromogenic anti-factor Xa assay calibrated with heparin standards shows a correlation between apixaban levels and LMWH levels.…”

Section: Discussionmentioning

confidence: 94%

Use of apixaban in children awaiting heart transplantation

Benvenuto,

Hartje‐Dunn,

et al. 2023

Pediatric Transplantation

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BackgroundThe use of apixaban in the pediatric cardiac population is expanding. We describe our apixaban dosing and monitoring strategy in children and young adults awaiting heart transplantation, along with outcomes related to bleeding and thrombosis during wait‐list and early post‐transplant periods.MethodsThis study is a retrospective, single‐center analysis of all patients receiving apixaban while awaiting cardiac transplantation. Weight‐based dosing was monitored with peak drug‐specific anti‐Xa chromogenic analysis. Significant post‐operative bleeding defined by chest tube output or need for surgical intervention.ResultsFrom September 2020 to December 2022, 19 patients, median age 13.5 years (6.1, 15.8 years), weighing 48.9 kg (15.4, 67.6) received apixaban while awaiting transplant. Indication for apixaban was prophylaxis (n = 18, 3 with ventricular assist devices) and treatment of thrombus (n = 1). There were no clinically relevant non‐major or major bleeding, nor thrombotic events while awaiting transplant. The median time from last apixaban dose to arrival in the operating room was 23.2 h (15.6–33.8), with median random apixaban level of 37 ng/mL (28.3, 59), 6.3 h (4.8, 8.4) prior to arrival in the operating room. In this study, 32% of patients had significant post‐operative bleeding based on chest tube output post‐transplant or need for intervention. No patients meeting criteria for significant post‐operative bleeding were thought to be attributable to apixaban.ConclusionsCareful use of apixaban can be safe and effective while awaiting heart transplant. There was no appreciable increase in peri‐operative bleeding. The use of apixaban is promising in providing safe, predictable and efficacious anticoagulation while avoiding additional patient stressors.

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Section: Discussionmentioning

confidence: 94%

Use of apixaban in children awaiting heart transplantation

Benvenuto,

Hartje‐Dunn,

et al. 2023

Pediatric Transplantation

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“…This finding has to be interpreted with caution due to the fact that no data on anticoagulation were analyzed and because there are known differences between anticoagulation protocols in Europe, even when using the same device [ 26 ]. In a recently published study, apixaban, together with low-dose aspirin, was safe and effective in children supported with an HM3 device [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Use of Intracorporeal Durable LVAD Support in Children Using HVAD or HeartMate 3—A EUROMACS Analysis

Schweiger,

Hussein,

de By

et al. 2023

JCDD

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Purpose: The withdrawal of HVAD in 2021 created a concern for the pediatric population. The alternative implantable centrifugal blood pump HeartMate 3 has since been used more frequently in children. This paper analyses the outcome of children on LVAD support provided with an HVAD or HM3. Methods: A retrospective analysis of the EUROMACS database on children supported with VAD < 19 years of age from 1 January 2009 to 1 December 2021 was conducted. All patients with an LVAD and either an HVAD or HM3 were included. Patients with missing data on VAD status and/or missing baseline and/or follow up information were excluded. Kaplan–Meier survival analysis was performed to evaluate survival differences. Analyses were performed using Fisher’s exact test. Results: The study included 150 implantations in 142 patients with 128 implants using an HVAD compared to 28 implants using an HM3. Nine patients (6%) needed temporary right ventricular mechanical support, which was significantly higher in the HM3 group, with 25% (p: 0.01). Patients in the HVAD group were significantly younger (12.7 vs. 14.5 years, p: 0.01), weighed less (45.7 vs. 60 kg, p: <0.000) and had lower BSA values (1.3 vs. 1.6 m2, p: <0.000). Median support time was 204 days. Overall, 98 patients (69%) were discharged and sent home, while 87% were discharged in group HM3 (p: ns). A total of 123 children (86%) survived to transplantation, recovery or are ongoing, without differences between groups. In the HVAD group, 10 patients (8%) died while on support, whereas in 12% of HM3 patients died (p: 0.7). Conclusions: Survival in children implanted with an HM3 was excellent. Almost 90% were discharged and sent home on the device.

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“…Since our initial report, there have been other small series reporting similar excellent outcomes. 1 As noted by Mahr, 2 and why we chose Apixaban for our patients, there are potential advantages to Apixaban over other direct oral anticoagulants to account for its success. Apixaban is now our standard of care.…”

Section: To the Editormentioning

confidence: 94%