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Comparison of Anticoagulation Strategies After Left Ventricular Assist Device Implantation

Alexander Kantorovich1, Jodie M Fink, Michael A Militello

  • 1From the *Department of Pharmacy Practice, Chicago State University College of Pharmacy, Chicago, Illinois; †Department of Pharmacy, Advocate Christ Medical Center, Oak Lawn, Illinois; ‡Department of Pharmacy, University Hospitals Ahuja Medical Center, Beachwood, Ohio; §Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio; and ¶Department of Cardiovascular and Thoracic Surgery, Cleveland Clinic, Cleveland, Ohio.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|December 23, 2015
PubMed

Insights

Early heparin anticoagulation after left ventricular assist device (LVAD) implantation significantly reduces thrombotic complications. However, this strategy may increase bleeding risk compared to no bridging.

Area of Science:

  • Cardiology
  • Medical Devices
  • Pharmacology

Background:

  • Establishing optimal early anticoagulation post-left ventricular assist device (LVAD) implantation remains a clinical challenge.
  • Current practices vary widely, from no anticoagulation to early heparinization, impacting patient outcomes.

Purpose of the Study:

  • To evaluate the efficacy and morbidity of three distinct anticoagulation strategies prior to oral anticoagulation initiation in LVAD patients.
  • To compare thrombotic complications and bleeding events associated with different early anticoagulation regimens.

Main Methods:

  • Retrospective, noninterventional, matched historical control cohort study design.
  • Primary endpoints: thrombotic complications (TCs). Secondary endpoints: bleeding events up to 30 days post-LVAD implantation.
  • Comparison of three strategies: no bridging, early heparinization, and bivalirudin bridging.

Main Results:

  • A significant difference in overall TCs was observed between strategies (p = 0.017).
  • Heparin significantly reduced TCs (4.9% vs. 27.0%, p = 0.008) compared to no bridging, confirmed by multivariate analysis (OR, 0.10; 95% CI, 0.01-0.85).
  • Heparin was independently associated with increased bleeding risk (OR, 2.93; 95% CI, 1.15-7.43), while bivalirudin showed no significant difference in TCs or bleeding versus no bridging.

Conclusions:

  • Early heparinization appears most effective in reducing thrombotic complications after LVAD implantation.
  • The benefits of heparin in preventing TCs must be weighed against its potential to increase bleeding risk.
  • Bivalirudin did not offer significant advantages over no bridging for early anticoagulation post-LVAD.

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