Preoperative atrial fibrillation may not increase thromboembolic events in left ventricular assist device recipients on midterm follow-up

Yu, Xia; Stern, David; Friedmann, Patricia; Goldstein, Daniel J.

doi:10.1016/j.healun.2016.03.003

Cited by 30 publications

(16 citation statements)

References 20 publications

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“…Xuereb et al reported that 12.8% of patients with AF and 9.3% of patients with NAF had concomitant aortic valve replacement or repair. In the study by Xia et al, 3.8% of patients with AF and 4.4% of patients with NAF had concomitant aortic valve replacement or repair. In addition, 4.7% of patients with AF and 4% of patients with NAF had concomitant mitral valve replacement or repair.…”

Section: Resultsmentioning

confidence: 95%

“…Another study was excluded because it did not provide adequate information to calculate a risk ratio. 11 Seven retrospective observational studies published between 2013 and 2018 [12][13][14][15][16][17][18] were included in this metaanalysis as shown in Table 1. Most of the studies examined patients undergoing LVAD implantation in the United States except for one study which was conducted in Europe (Germany).…”

Section: Resultsmentioning

confidence: 99%

“…The AF group is associated with more advanced comorbidities as shown in Table including older age, which is known to be a risk factor of poorer outcome after implantation of LVAD . In addition, the study by Xia et al has shown that AF was significantly associated with decreased survival in univariate analysis, but it was not significant in multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

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Impact of preoperative atrial fibrillation in patients with left ventricular assist device: A systematic review and meta‐analysis

et al. 2019

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Atrial fibrillation (AF) is a common finding in patients evaluated for left ventricular assist device (LVAD). There is conflicting data regarding the mortality risk as well as the thromboembolic risk in patients with preoperative AF who undergo LVAD implantation. We examined these risks by performing a meta‐analysis. We performed a literature search of Pubmed, EMBASE, SCOPUS, and Cochrane from inception to February 2018. The eligible studies were used to compare mortality rate and thromboembolic risk between AF and Non‐AF (NAF) groups after LVAD implantation. We obtained 391 articles from our search strategy. Seven retrospective studies were included and accounted for 5823 LVAD patients (AF 1589; NAF 4234). The median follow‐up duration ranged from 7–24 months. The pooled analysis revealed a significantly increased risk of mortality in preoperative AF patients who underwent LVAD operation compared to those with NAF (Risk Ratio [RR] 1.16, 95% CI 1.05‐1.28, I2 = 0%). Five studies reported thromboembolism events involving 1359 preoperative AF and 3893 NAF patients. The pooled analysis did not show a statistically significant association between risk of thromboembolic event and preoperative AF (Risk Ratio [RR] 1.08, 95% CI 0.86‐1.36, I2 = 76.2%). Our study shows that preoperative AF may be associated with a higher mortality rate. This study is limited by the fact that the data are pooled from retrospective studies. Further prospective studies are warranted in order to validate these results.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of preoperative atrial fibrillation in patients with left ventricular assist device: A systematic review and meta‐analysis

et al. 2019

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“…A meta-analysis of 7 studies on 5,685 patients demonstrated that preoperative AF does not increase the risk of all-cause mortality, risk of thromboembolism, pump thrombosis or major bleedings after LVAD implantation in the 1-year follow-up but it was significantly associated with postoperative gastrointestinal bleeding [57]. Also other studies, based on the INTERMACS registry, did not confirm the increased rate of thromboembolic events or mortality in case of preoperative AF [58]. Kurihara et al [59] compared 229 patients with preoperative AF and 297 patients without AF undergoing HM II or HVAD implantation.…”

Section: Af Before Lvad Implantationmentioning

confidence: 99%

Insight into Atrial Fibrillation in LVAD Patients: From Clinical Implications to Prognosis

Sisti¹,

Mandoli²,

Sciaccaluga³

et al. 2020

Pulse

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The use of left ventricular assist devices (LVADs), whether for destination therapy or bridge to transplantation, has gained increasing validation in recent years in patients with advanced heart failure. Arrhythmias can be the most challenging variables in the management of such patients but the main attention has always been focused on ventricular arrhythmias given the detrimental impact on mortality. Nevertheless, atrial fibrillation (AF) is the most common rhythm disorder associated with advanced heart failure and may therefore characterize the LVADs' pre-and postimplantation periods. Indeed, the consequences of AF in the population suffering from standard heart failure may require a more comprehensive evaluation in the presence of or in sight of an LVAD, making the AF clinical management in these patients potentially complex. Several studies have been based on this subject with different and often conflicting results, leaving many questions unresolved. The purpose of this review is to summarize the main pieces of evidence about the clinical impact of AF in LVAD patients, underlining the main implications in terms of hemodynamics, thromboembolic risk, bleeding and prognosis. Therapeutic considerations about the clinical management of these patients are also made according to the latest evidence.

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“…Atrial fibrillation (AF) is a well-established risk factor for thromboembolic complications and is common in patients with severe heart failure, including LVAD implantation patients. However, a recent retrospective analysis of the INTERMACS data from primary LVADs suggests that preoperative AF does not increase the risk of postoperative thromboembolic complications or mortality during the interim period [18]. This indicates that the usual post-operative antithrombotic strategy most likely is also suitable for patients with AF that undergo LVAD implantation.…”

Section: Original Researchmentioning

confidence: 99%

Hemorrhagic and thromboembolic complications in patients with implanted left ventricular assist devices in early postoperative period

Mazurenko

Nadzyakevich

Лоскутов

et al. 2019

Pain Anaesth Int Care

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The work is devoted to study hemorrhagic and thromboembolic complications in early postoperative period after implantation of left ventricular assist devices (LVAD).We performed retrospective analysis of 10 patients, males aged 55±13.5 years, with a BMI of 30.8±8.3, with a left ventricular ejection fraction ranging from 9% to 28%, which in the period from 11.03.2016 to 22.11.2017 year, in the Silesian center of the Heart Disease (Poland), in conditions of artificial blood circulation, LVAD was implanted.In the early postoperative period, patients received daily anticoagulant target therapy (ACCT), consisting of the following drugs: heparin (6-11 U/kg/h), aspirin (75-150 mg), Clopidogrel (75-150 mg), warfarin (1.5-7 mg), Nadroparinum Ca (0.3-0.6 ml/twice on day), Fondaparinux Na (2.5-5 mg/twice on day). Two patients received mono-heparin therapy, one patient received monotherapy with warfarin for 14 days. Other patients during the same period received combined heparin therapy in the first three days with a subsequent transition to warfarin, aspirin, Clopidogrel, Fraxiparin, or thrombin blocker.The mechanical support of the left ventricle was carried out essentially by two different implantable systems, performing one function of support of the left ventricle: POLVAD -programmed controlled pneumatic membrane mechanical circulation of blood to two patients, and LVAD programcontrolled electro-centrifugal circulation for eight patients. The duration of support by POLVAD system was from 102 to 156 days. Length of support -LVAD ranged from 20 to 78 days.A comparison of the analyzed results led to the conclusion that anticoagulant mono-therapy with heparin or warfarin leads to an increase in the percentage of complications and mortality compared with the alternative combination anticoagulant targeted therapy consisting of the following drugs: heparin (6-11 U/kg/h), aspirin 75-150 mg), Clopidogrel (75-150 mg), warfarin (1.5-7 mg), Nadroparinum Ca (0.3-0.6 ml/ twice on day), Fondaparinux Na (2.5-5 mg/ twice on day), Where survival rates were significantly higher by 60%.

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Preoperative atrial fibrillation may not increase thromboembolic events in left ventricular assist device recipients on midterm follow-up

Cited by 30 publications

References 20 publications

Impact of preoperative atrial fibrillation in patients with left ventricular assist device: A systematic review and meta‐analysis

Impact of preoperative atrial fibrillation in patients with left ventricular assist device: A systematic review and meta‐analysis

Insight into Atrial Fibrillation in LVAD Patients: From Clinical Implications to Prognosis

Hemorrhagic and thromboembolic complications in patients with implanted left ventricular assist devices in early postoperative period

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