Apixaban versus warfarin for anticoagulation after left ventricular assist device implantation: A multicenter...

Anticoagulation is standard in patients with left ventricular assist devices (LVADs), but the optimal regimen remains uncertain. While warfarin has historically been utilized, the use of direct oral anticoagulants is increasing. Using the TriNetX Collaborative Research Network, we identified adult HeartMate 3 (HM3) LVAD recipients treated with apixaban (n = 174) or warfarin (n = 1782). Propensity-score matching balanced demographics, comorbidities, and laboratory values, yielding 171 patients per cohort. The mean age was 53.3 ± 16.9 years in the apixaban group and 54.2 ± 15.3 years in the warfarin group, with males comprising 75% and 72%, respectively. All-cause mortality (14% vs. 16%; HR 0.88, p = 0.65) and stroke (14% vs. 17%; HR 0.83, p = 0.50) did not differ significantly. Gastrointestinal bleeding was significantly lower with apixaban (12% vs. 25%; HR 0.51, p = 0.01). These observational analyses support apixaban as a feasible alternative anticoagulation strategy in HM3 LVAD recipients.