Anticoagulant Bridge Comparison in Mechanical Circulatory Support Patients

Area of Science:

• Cardiology
• Hematology
• Medical Devices

Background:

• Maintaining anticoagulation within a therapeutic range is challenging for mechanical circulatory support (MCS) device patients.
• Subtherapeutic International Normalized Ratios (INRs) are frequent with warfarin therapy, necessitating effective bridging strategies.

Purpose of the Study:

• To compare the efficacy and safety of subcutaneous enoxaparin or fondaparinux versus intravenous unfractionated heparin (UFH) as anticoagulant bridging strategies in MCS patients with subtherapeutic INRs.

Main Methods:

• Retrospective review of MCS patients with subtherapeutic INRs.
• Comparison of intravenous UFH with subcutaneous enoxaparin or fondaparinux.
• Evaluation of anticoagulant effect using native thromboelastography (n-TEG) with coagulation index (CI) as the primary outcome.

Main Results:

• All anticoagulant strategies (UFH, enoxaparin, fondaparinux) demonstrated statistically similar frequencies of achieving the n-TEG goal range.
• Clinical outcomes, including bleeding events and device thrombosis, were comparable across the groups.
• One patient in the UFH group experienced device thrombosis; ischemic cerebrovascular accident events occurred in one UFH and one fondaparinux patient.

Conclusions:

• Low-dose subcutaneous enoxaparin or fondaparinux may serve as viable alternative anticoagulant bridging options for MCS patients with subtherapeutic INRs.
• These strategies offer comparable n-TEG results and clinical outcomes to intravenous UFH.