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Anticoagulation strategies for left ventricular assist devices

Hadi Toeg1, Marc Ruel1, Haissam Haddad2

  • 1Division of Cardiac Surgery.

Current Opinion in Cardiology
|January 10, 2015
PubMed

Insights

Pump thrombosis is a serious complication for patients with left ventricular assist devices (LVADs). This review examines current strategies for anticoagulation and antithrombotic therapy to manage LVAD pump thrombosis and prevent complications.

Area of Science:

  • Cardiology
  • Medical Devices
  • Thrombosis Research

Background:

  • Left ventricular assist devices (LVADs) are crucial for heart failure management.
  • Pump thrombosis is a significant and potentially devastating complication in LVAD patients.
  • Current treatment options, including intravenous anticoagulation, can lead to further complications.

Purpose of the Study:

  • To review current antithrombotic and anticoagulation strategies for LVAD patients.
  • To discuss management approaches for suspected pump thrombosis.
  • To highlight recent trends and guidelines related to LVAD thrombosis.

Main Methods:

  • Literature review of antithrombotic and anticoagulation strategies.
  • Analysis of recent trends in LVAD pump thrombosis (HeartMate II).
  • Discussion of International Society for Heart and Lung Transplantation (ISHLT) guidelines.

Main Results:

  • A notable increase in HeartMate II pump thrombosis was observed starting March 2011.
  • Changes in perioperative anticoagulation, lower target INR, and lack of heparin bridging may contribute to increased thrombosis.
  • ISHLT has published guidelines for LVAD anticoagulation and pump thrombosis management.

Conclusions:

  • Evidence for thromboprophylaxis in LVAD patients is limited.
  • ISHLT guidelines provide minimum criteria for perioperative anticoagulation based on low-level evidence.
  • Individualized anticoagulation strategies are essential to balance thromboprophylaxis and bleeding risk.
Abstract

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