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Updated: Nov 15, 2025
11:17
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
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Enoxaparin Use and Adverse Events in Outpatients With a Continuous Flow Left Ventricular Assist Device at a Single
Allison M Bernard1, Paulino A Alvarez2, Heather R Bream-Rouwenhorst1
1Department of Pharmaceutical Care, The University of Iowa Hospitals and Clinics, University of Iowa Health Care, Iowa City, IA, USA.
Journal of Pharmacy Practice
|March 2, 2021
Summary
Enoxaparin bridging for left ventricular assist device (LVAD) patients with low INR is safe and effective. This strategy showed a low rate of bleeding and thrombotic events in LVAD recipients.
Area of Science:
- Cardiology
- Pharmacology
- Medical Devices
Background:
- Patients with left ventricular assist devices (LVADs) require warfarin anticoagulation.
- Subtherapeutic international normalized ratio (INR) levels may necessitate enoxaparin bridging.
- Current guidelines for enoxaparin bridging in LVAD patients are lacking, creating uncertainty in dosing strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of enoxaparin bridging in LVAD patients with subtherapeutic INR.
- To characterize the incidence of thrombotic and major bleeding events (MBE) associated with enoxaparin bridging.
Main Methods:
- Retrospective review of LVAD patients from June 2017 to June 2018.
- Patients divided into enoxaparin exposure and non-exposure cohorts.
- Events classified as related to enoxaparin if occurring during or shortly after its administration.
Main Results:
- Seventy-one LVAD patients met inclusion criteria; 50 received enoxaparin bridging.
- Therapeutic-dose enoxaparin was administered for a mean of 2.8 days.
- One MBE and one thrombotic event occurred post-enoxaparin discontinuation, with elevated INR levels.
Conclusions:
- Short-duration, therapeutic-dose enoxaparin bridging appears to have a low rate of adverse events in LVAD patients.
- Further prospective studies are needed to refine anticoagulation bridging strategies, potentially considering LVAD device type.
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