Efficacy and safety of apixaban versus warfarin in LVAD patients: A propensity-matched analysis

Aim: The primary endpoint was the incidence of major HRAEs. Secondary endpoints included LVAD thrombosis, stroke, major bleeding, non-central nervous system thromboembolism, and all-cause mortality.

Materials and Methods: We conducted a multicenter retrospective cohort study using the TriNetX database, identifying LVAD patients receiving either warfarin or apixaban. Two cohorts were established based on anticoagulation regimen, and propensity score matching was employed to minimize baseline differences.

Results: After matching, 3,129 patients were included in each group. HRAEs occurred less frequently in the apixaban cohort (19.7%) than in the warfarin cohort (28.4%) (OR: 0.618; 95% CI: 0.513-0.744; P < 0.001). Apixaban was also associated with significantly fewer LVAD thrombosis events (OR: 0.088), strokes (OR: 0.721), and major bleeding events (OR: 0.528). Rates of non-CNS thromboembolism and all-cause mortality were similar between groups.

Conclusions: Although warfarin remains the standard anticoagulant for LVAD recipients, apixaban demonstrated lower rates of major adverse events in this large retrospective analysis. Further prospective and randomized studies are warranted to confirm these findings and inform future clinical practice.