Anticoagulation of HeartMate 3 Left Ventricular Assist Device With Apixaban

We report a case of a 56-year-old man requiring a HeartMate 3 after a myocardial infarction and limited recovery on a temporary ventricular assist device. Because of several gastrointestinal bleeding complications and nonadherence, his antithrombotic therapy was switched from warfarin and aspirin to apixaban 5 mg twice daily. We also determined several peak anti-factor Xa levels for ongoing monitoring. Direct oral anticoagulants may be an option for the prevention of pump thrombosis in patients who are unable to tolerate or refuse warfarin therapy.