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Omission of Antiplatelet Therapy in Patients With HeartMate 3 Left Ventricular Assist Devices: A Systematic Review
Maximilian Tscharre1,2, David Mutschlechner3, Thomas Schlöglhofer4
1From the Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 10, 2024
Summary
Vitamin K antagonist monotherapy significantly reduces bleeding events in HeartMate 3 patients. This approach lowers hemocompatibility-related adverse events without increasing thromboembolic risks.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Pharmacology
Background:
- The HeartMate 3 (HM3) left ventricular assist device (LVAD) reduces thromboembolic events but high bleeding complications persist with combined antithrombotic therapy (VKA and aspirin).
- Limited data exists on the safety of vitamin K antagonist (VKA) monotherapy in HM3 patients.
Approach:
- A systematic literature search identified observational studies and randomized trials evaluating VKA monotherapy versus VKA and aspirin in HM3 patients.
- Hemocompatibility-related adverse events (HRAE) were analyzed as the primary endpoint, with secondary analysis of individual event components.
- A random-effects model was used to calculate the odds ratio (OR) for outcome measures.
Key Points:
- Five studies including 785 patients (381 on VKA monotherapy, 404 on VKA and aspirin) were analyzed.
- VKA monotherapy significantly reduced HRAE (OR: 0.11) and bleeding complications (OR: 0.12).
- No significant increase in thromboembolic events was observed with VKA monotherapy (OR: 0.69).
Conclusions:
- Vitamin K antagonist monotherapy is associated with a significant reduction in bleeding events in HM3 patients.
- This approach does not increase the risk of thromboembolic complications.
- VKA monotherapy represents a safer antithrombotic strategy for HM3 patients compared to combined therapy.
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