Pharmacotherapy for durable left ventricular assist devices

Hollis, Ian B.; Doligalski, Christina T.; Jennings, Douglas

doi:10.1002/phar.2491

Cited by 9 publications

(10 citation statements)

References 116 publications

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“…16,17 Each type of ventricular assist device has its own requirement for anticoagulation based on clinical trials. 18 In addition, unlike most heart valves, LVAD patients typically require concomitant use of aspirin to reduce thrombotic risk (while unfortunately enhancing bleeding risk). 19,20 Lastly, LVADs are subject to thrombosis whereas leaflet thrombosis is much less common with heart valves.…”

Section: Discussionmentioning

confidence: 99%

Protocol-based anticoagulation management for mechanical circulatory support patients can be safe and efficient

et al. 2022

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Background: Achieving optimal anticoagulation remains a significant challenge in managing patients on left ventricular assist device (LVAD) support. Maintaining tight control of anticoagulation can be time-consuming but essential in preventing serious complications such as pump thrombosis and bleeding. Objectives: The efficacy and safety of a nurse coordinator-driven outpatient protocol (NCDOP) was evaluated for managing anticoagulation for LVAD patients. Methods: A retrospective analysis was performed as part of a single-center quality improvement project. The primary outcome was time in therapeutic range (TTR), a measure of anticoagulation target efficacy before and after the implementation of the protocol. Results: Among 47 patients, who served as their own control, there was no significant change in TTR or proportion of hospitalizations following institution of the protocol. Pre-NCDOP, there were six major bleeding and two thrombotic events, and none during the post-NCDOP period. Conclusions: A NCDOP is a reliable method to manage anticoagulation in LVAD patients and facilitates efficient care delivery. Future multicenter studies with larger patient cohorts are warranted to expand on the findings outlined in this manuscript.

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Section: Discussionmentioning

confidence: 99%

Protocol-based anticoagulation management for mechanical circulatory support patients can be safe and efficient

et al. 2022

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“…In LVAD patients with pre-op AF, the predisposition to TE events is conflicting in the literature. Certain studies have indicated no differences in postoperative TE between patients with pre-op AF and no pre-op AF [43,58,59] . Enriquez et al found similar rates of TE events in LVAD patients with and without AF (17% incidence), although AF patients had higher INR levels (INR 2.3 vs. 1.5 in the four weeks leading to the TE events) [14] .…”

Section: Hemocompatibility Related Adverse Events and Management Of A...mentioning

confidence: 99%

Atrial fibrillation in mechanical circulatory support patients

Obeid¹,

Yaligar²,

McLarty³

et al. 2022

Vessel Plus

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Atrial fibrillation (AF) is known to be one of the most common arrhythmias noted in cardiac procedures and is frequently associated with heart failure. As frequent interventions for patients with heart failure involve implantation of mechanical circulatory assist devices (e.g., left ventricular assist devices), it is timely to review the role this arrhythmia has on adverse clinical outcomes. A comprehensive literature search was conducted for PubMed. Relevant medical subject heading (MeSH) terms used in the initial literature search include “Heart-Assist Devices”, “Extracorporeal Membrane Oxygenation”, “Atrial Fibrillation”, “Heart Failure”, “Mortality”, “Hospital Readmission”, “stroke”, “Postoperative Complications”. In this review, the relevant literature was highlighted to identify the incidence, clinical impacts, and management of AF surrounding mechanical circulatory support implantation. The incidence of AF in this mechanical circulatory support device population was similar to that of patients with other cardiac procedures (10%-40%). Moreover, in most studies, preoperative AF was not significantly associated with adverse outcomes. In contrast, however, it appears that postoperative atrial fibrillation may predispose patients to increased risk for thromboembolic events and adverse long-term outcomes.

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“…Third-generation (centrifugal-flow) LVADs reduced the hemocompatibility-related events, but the stroke incidence remained high [ 4 , 5 , 6 , 7 ]. For this reason, further improvements in LVAD technology, along with new pharmacological treatments, are necessary to optimize patient management and to further reduce hemocompatibility-related events [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Post-Implant Phosphodiesterase-5 Inhibitors in Patients with Left Ventricular Assist Device: A Systematic Review and Meta-Analysis

Xanthopoulos

Magouliotis

Tryposkiadis³

et al. 2022

JCM

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Background: Despite the improvement in left ventricular assist device (LVAD) technology and the advent of third-generation LVADs, hemocompatibility-related events remain a significant issue. Therefore, new pharmacological treatments are necessary to optimize patient management and to further reduce hemocompatibility-related events. The purpose of the present systematic review and meta-analysis was to summarize the existing data regarding the safety and efficacy of post-implant phosphodiesterase-5 inhibitors (PDE-5i) on hemocompatibility-related events. Methods: Among the 258 articles in Pubmed, Scopus, and CENTRAL that were retrieved (1990–2022), 15 studies were included in the qualitative synthesis, and 9 studies were included in the quantitative synthesis. The fixed-effects model was used because it is statistically sound for combining a very small number of studies. The primary endpoint of the study was all-cause mortality, whereas the secondary endpoints were ischemic stroke, pump thrombosis, and gastrointestinal bleeding. Results: Mortality was significantly lower in the PDE-5i group vs. the control group (OR: 0.92 [95% CI: 0.85, 0.98]; p = 0.02). The secondary endpoints ischemic stroke (OR: 0.87 [95% CI: 0.78, 0.98]; p = 0.02) and pump thrombosis (OR: 0.90 [95% CI: 0.82, 0.99]; p = 0.04) were also lower in the PDE-5i group. The incidence of gastrointestinal bleeding was significantly higher in patients with LVAD receiving PDE-5i (OR: 1.26 [95% CI: 1.11, 1.44]; p < 0.01). In the overall analysis, the heterogeneity of outcomes was low, except for pump thrombosis. Conclusions: The use of PDE-5i post-implant was associated with lower mortality and thrombotic events but with a higher risk of gastrointestinal bleeding.

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Pharmacotherapy for durable left ventricular assist devices

Cited by 9 publications

References 116 publications

Protocol-based anticoagulation management for mechanical circulatory support patients can be safe and efficient

Protocol-based anticoagulation management for mechanical circulatory support patients can be safe and efficient

Atrial fibrillation in mechanical circulatory support patients

Post-Implant Phosphodiesterase-5 Inhibitors in Patients with Left Ventricular Assist Device: A Systematic Review and Meta-Analysis

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