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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
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Triple Antithrombotic Therapy in Patients With Left Ventricular Assist Devices
Selim R Krim1, Amanda Bennett2, Michael Pfeffer3
1Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Current Problems in Cardiology
|August 13, 2021
Summary
Dual-antiplatelet therapy with warfarin in left ventricular assist device (LVAD) patients showed reduced pump thrombosis risk without increasing bleeding or stroke. This study provides valuable insights into antithrombotic strategies for LVAD recipients.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis Research
Background:
- Left ventricular assist devices (LVADs) require antithrombotic therapy to prevent device-related complications.
- Limited data exists comparing dual-antiplatelet therapy (DAPT) with mono-antiplatelet therapy (MAPT) in conjunction with warfarin for LVAD patients.
Purpose of the Study:
- To compare the efficacy and safety of warfarin plus DAPT versus warfarin plus MAPT in LVAD patients.
- To evaluate outcomes including bleeding, stroke, and pump thrombosis at one year post-LVAD implantation.
Main Methods:
- A single-center study included 130 consecutive patients with durable LVADs.
- Patients were divided into two groups: warfarin plus DAPT (Group 1) and warfarin plus MAPT (Group 2).
- Outcomes were assessed at one year, focusing on gastrointestinal bleeding, ischemic and hemorrhagic stroke, mortality, and pump thrombosis.
Main Results:
- No significant differences were observed in gastrointestinal bleeding, stroke, or mortality between the two groups.
- Group 1 (warfarin plus DAPT) demonstrated a statistically significant lower rate of pump thrombosis compared to Group 2 (warfarin plus MAPT) (0% vs 6.5%, P=0.033).
- Higher lactate dehydrogenase levels and a history of stroke were more common in Group 1 at discharge.
Conclusions:
- Triple-therapy antithrombotic use (warfarin plus DAPT) in LVAD patients is prevalent.
- While not significantly increasing bleeding or stroke risk, DAPT with warfarin may reduce the risk of pump thrombosis in LVAD patients.
- Further research is warranted to optimize antithrombotic strategies in LVAD recipients.
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