Apixaban as therapeutic anticoagulation in patients supported by a fully magnetically levitated left ventricular...

The HeartMate 3 left ventricular assist device is an established therapy for patients with advanced heart failure. Warfarin has been the recommended anticoagulant for patients supported by the HeartMate 3 left ventricular assist device; however, it is accompanied by complications secondary to the lack of time in therapeutic range, dosage-related issues, and medical burden. In this study, we present our experience with apixaban as an alternative primary and chronic anticoagulant for patients supported with the HeartMate 3 left ventricular assist device.

We performed a single-center retrospective review of patients who were supported with the HeartMate 3 left ventricular assist device from January 2018 to October 2025 who were treated with apixaban as the primary and chronic anticoagulant. The Interagency Registry for Mechanically Assisted Circulatory Support database was used to evaluate patient clinical data and adverse events. Patients were assessed for survival and adverse events, including bleeding, stroke, pump thrombosis, and hemolysis.

A total of 113 patients supported with the HeartMate 3 left ventricular assist device were treated with apixaban as the primary and chronic anticoagulant. Patients had a mean age of 57 years and were predominantly male (70%) and White (71%); 41% were diagnosed with ischemic cardiomyopathy, 25% with idiopathic cardiomyopathy, and 21% with other cardiomyopathies. By Interagency Registry for Mechanically Assisted Circulatory Support profile, patients were classified as 12% profile 1, 35% profile 2, 43% profile 3, and 10% profile 4. There was a total of 272.8 patient-years on apixaban with a mean of 2.4 years. A total of 23 patients (20%) experienced a bleeding event. There were 0.158 bleeding events per patient-year with only 0.062 severe bleeding events per patient-year. Twelve patients had 12 strokes (10%) with 0.022 ischemic stroke events per patient-year. There was no pump thrombosis or hemolysis events. Survival at 1 year and 5 years was 86% and 51%, respectively.

Apixaban is a safe and effective primary and chronic therapeutic anticoagulant for patients on a HeartMate 3 left ventricular assist device.