Oral anticoagulation in patients with ventricular assist devices

Nine men aged 25-63 years (mean 42 years) received pulsatile ventricular assist devices (VADs) as a bridge to cardiac transplantation. Duration of support ranged from 8-266 days (mean 70.7 days); seven patients (pts.) were bridged with a LVAD and two received BVADs. All pts. were maintained on oral anticoagulants after initial intravenous (IV) heparin or dextran therapy. During warfarin therapy, supplemental IV heparin was used only if the prothrombin time fell below 1.5 times control (approximately 30% activity). In 639 days of support, there was one thromboembolic event due to mechanical failure, and one pt. had thrombus in the VAD which did not embolize.