Hemocompatibility Outcomes After Aspirin Withdrawal in Long-Term HeartMate 3 Left Ventricular Assist Device Patients...

Left Ventricular Assist Devices, particularly Heart Mate 3 (HM3), have improved outcomes for advanced heart failure patients. Despite advancements, hemocompatibility-related adverse events (HRAEs) continue to pose significant challenges. Standard antithrombotic therapy combines vitamin K antagonists (VKAs) with aspirin, though the ARIES-HM3 trial showed aspirin avoidance from implantation reduces bleeding without increasing thrombotic events. Whether discontinuing aspirin in stable, long-term HM3 patients is safe remains unclear.

This retrospective single-center study included 44 HM3 recipients maintained on VKA plus low-dose aspirin who underwent aspirin discontinuation while clinically stable. HRAEs, neurological events, nonsurgical bleeding and pump thrombosis, were assessed during two 6-month intervals: pre- and post- aspirin withdrawal. Secondary endpoints included individual HRAE components and hemolysis markers (lactate dehydrogenase [LDH] and hemolysis index [HI]).

Mean age at discontinuation was 59.6 ± 13.1 years, with median LVAD support duration of 952.5 days. HRAEs occurred in four patients (9.1%) before discontinuation versus three patients (6.8%) after (p = 1.00). Neurological events (2.3% in both periods) and pump thrombosis (2.3% in both periods) were rare. Bleeding declined from 7.0% to 2.3% (p = 0.63), with no gastrointestinal bleeding after aspirin discontinuation. LDH remained unchanged (220 vs. 218 U/L, p = 0.89), while HI rose (Median 3 vs. 5, p = 0.008) but stayed within normal range.

In long-term, stable HM3 recipients on VKA therapy, aspirin discontinuation did not increase HRAEs. Laboratory markers of hemolysis remained stable aside from a modest, clinically insignificant rise in HI. These findings extend randomized evidence supporting aspirin avoidance at implantation to patients with long-term HM3 support and suggest simplified antithrombotic regimens may be safe in selected HM3 patients. Larger multicenter studies with longer follow-up are warranted.