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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Discontinuation of antithrombotic therapy for a year or more in patients with continuous-flow left ventricular assist

Naveen L Pereira1, Dong Chen, Sudhir S Kushwaha

  • 1Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA. pereira.naveen@mayo.edu

Interactive Cardiovascular and Thoracic Surgery
|July 20, 2010
PubMed

Insights

Patients with left ventricular assist devices (LVADs) experiencing gastrointestinal bleeding may safely discontinue anticoagulation if they have an acquired von Willebrand factor (VWF) abnormality, avoiding thrombotic events.

Area of Science:

  • Cardiology
  • Hematology
  • Medical Devices

Background:

  • Continuous-flow axial left ventricular assist devices (LVADs) require anticoagulation with aspirin and warfarin (target INR 2.0-3.0).
  • Recurrent gastrointestinal bleeding is a known complication in LVAD patients on anticoagulation.

Observation:

  • Two LVAD patients with recurrent gastrointestinal bleeding required discontinuation of anticoagulation for over a year.
  • Neither patient experienced thrombotic complications during 29 months of follow-up after stopping anticoagulation.

Findings:

  • Both patients demonstrated an acquired von Willebrand factor (VWF) abnormality, characterized by reduced high-molecular-weight multimers.
  • Platelet function tests were normal, suggesting an acquired VWF syndrome as the primary hemostatic defect.

Implications:

  • Discontinuation of standard anticoagulation may be feasible in select LVAD patients with acquired VWF abnormalities.
  • Further clinical trials are necessary to validate the safety of reduced or absent anticoagulation in this patient population.

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