Antiplatelet and Anticoagulation Strategies for Left Ventricular Assist Devices

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2021 Apr 14

PMID 33850918

Citations 12

Authors

Renzo Y Loyaga-Rendon

Toshinobu Kazui

Deepak Acharya

Affiliations

Soon will be listed here.

Abstract

Left ventricular assist devices (LVAD) have revolutionized the management of advanced heart failure. However, complications rates remain high, among which hemorrhagic and thrombotic complications are the most important. Antiplatelet and anticoagulation strategies form a cornerstone of LVAD management and may directly affect LVAD complications. Concurrently, LVAD complications influence anticoagulation and anticoagulation management. A thorough understanding of device, patient, and management, including anticoagulation and antiplatelet therapies, are important in optimizing LVAD outcomes. This article provides a comprehensive state of the art review of issues related to antiplatelet and anticoagulation management in LVADs. We start with a historical overview, the epidemiology and pathophysiology of bleeding and thrombotic complications in LVADs. We then discuss platelet and anticoagulation biology followed by considerations prior to, during, and after LVAD implantation. This is followed by discussion of anticoagulation and the management of thrombotic and hemorrhagic complications. Specific problems, including management of heparin-induced thrombocytopenia, anticoagulant reversal, novel oral anticoagulants, artificial heart valves, and noncardiac surgeries are covered in detail.

Citing Articles

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Left Ventricular Assist Device in Advanced Refractory Heart Failure: A Comprehensive Review of Patient Selection, Surgical Approaches, Complications and Future Perspectives.

Al Hazzouri A, Attieh P, Sleiman C, Hamdan R, Ghadieh H, Harbieh B Diagnostics (Basel). 2024; 14(22).

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To stop or not to stop novel oral anticoagulants prior to performing joint interventional maneuvers? Evidence from a prospective study that the therapy can be maintained.

Micu A, Micu M, Bodozs G, Dutu A Clin Rheumatol. 2024; 43(9):2983-2992.

PMID: 39008221 DOI: 10.1007/s10067-024-07048-6.

Long-term discontinuation of warfarin in a patient with HeartMate 3 left ventricular assist device without thromboembolic events.

Dharuman Y, Doss M, Risteski P, Popov A J Int Med Res. 2024; 52(6):3000605241258474.

PMID: 38901839 PMC: 11191603. DOI: 10.1177/03000605241258474.

Epistaxis Rates and Health Care Utilization in Patients With a Ventricular Assist Device.

Rohe E, Schmoker S, Samson K, Carlson K, Dowdall J OTO Open. 2024; 8(2):e132.

PMID: 38618289 PMC: 11009939. DOI: 10.1002/oto2.132.

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