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Anticoagulation in Mechanical Circulatory Support

  • Thoracic Transplantation (J Patel and AM Holm, Section Editors)
  • Published:
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Abstract

Purpose of Review

The field of mechanical circulatory support is rapidly evolving, and along with it, the management of anticoagulation and hemocompatibility also changes. The purpose of this review is to provide a contemporary approach to the evaluation and management of anticoagulation in mechanical circulatory support device therapies.

Recent Findings

Important recent studies and guidelines have solidified a more uniform approach to anticoagulation in both temporary and durable devices. With advances in technology, it may be possible to reduce the requirements for anticoagulant and antiplatelet therapies.

Summary

Though there are new technologies and management strategies being utilized, hemocompatibility between a patient and their mechanical circulatory support device remains of paramount importance for acceptable outcomes after device implantation. This must be individualized to each patient and performed within the context of a dedicated multidisciplinary team.

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References

  1. Editors, et al. American Association for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support. J Heart Lung Transplant. 2020;39(3):187-219.

  2. Fried J, Levin AP, Mody KM, Garan AR, Yuzefpolsakaya M, Takayama H, et al. Prior hematologic conditions carry a high morbidity and mortality in patients supported with continuous-flow left ventricular assist devices. J Heart Lung Transplant. 2014;33(11):1119–25.

    Article  Google Scholar 

  3. Slaughter MS, Naka Y, John R, Boyle A, Conte JV, Russell SD, et al. Post-operative heparin may not be required for transitioning patients with a HeartMate II left ventricular assist system to long-term warfarin therapy. J Heart Lung Transplant. 2010;29(6):616–24.

    Article  Google Scholar 

  4. Nemer DM, Stewart GC, Puligandla M, Neuberg DS, Givertz MM, Mehra MR, et al. Postoperative bridging anticoagulation and left ventricular assist system thrombosis. J Thromb Thrombolysis. 2019;47(1):57–66.

    Article  CAS  Google Scholar 

  5. Ton VK, Eisenberger A, Jennings D, Colombo PC, Topkara VK. Relationship of hemolysis with discordance in paired activated partial thromboplastin time and anti-Factor Xa measurements in continuous-flow left ventricular assist device patients. J Heart Lung Transplant. 2016;35(11):1365–7.

    Article  Google Scholar 

  6. Guglin M. What did we learn about VADs in 2016? The VAD Journal. 2017;3. https://doi.org/10.13023/VAD.2017.01.

  7. Andreas M, Moayedifar R, Wieselthaler G, Wolzt M, Riebandt J, Haberl T, Angleitner P, Schlöglhofer T, Wiedemann D, Schima H, Laufer G, Zimpfer D. Increased thromboembolic events with dabigatran compared with vitamin K antagonism in left ventricular assist device patients: a randomized controlled pilot trial. Circ Heart Fail. 2017;10(5):e003709. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003709

  8. Nassif ME, LaRue SJ, Raymer DS, Novak E, Vader JM, Ewald GA, Gage BF. Relationship between anticoagulation intensity and thrombotic or bleeding outcomes among outpatients with continuous-flow left ventricular assist devices. Circ Heart Fail. 2016;9(5):e002680. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002680

  9. Netuka I, Ivák P, Tučanová Z, Gregor S, Szárszoi O, Sood P, et al. Evaluation of low-intensity anti-coagulation with a fully magnetically levitated centrifugal-flow circulatory pump-the MAGENTUM 1 study. J Heart Lung Transplant. 2018;37(5):579–86.

    Article  Google Scholar 

  10. Schlöglhofer T, Zapusek L, Wiedemann D, Riebandt J, Wittmann F, Dimitrov K, Angleitner P, Haberl L, Laufer G, Moscato F, Zimpfer D, Schima H. International normalized ratio test frequency in left ventricular assist device patients affects anticoagulation quality and adverse events. ASAIO J. 2021;67(2):157–162. https://doi.org/10.1097/MAT.0000000000001206

  11. HeartMate II Left Ventricular Assist System Instructions for Use, Thoratec Corporation. Document: 10006960.C 2017.

  12. HeartWare HVAD System Instructions for Use. 2017. IFU00375 Rev03.

  13. Thoratec Corporation HeartMate 3 left ventricular assist system Instructions for Use. 2017. Document: 10006135.B.

  14. SynCardia Cardio West TAH-t Instructions for Use; SynCardia Systems, Inc.

  15. Saeed O, Colombo PC, Mehra MR, Uriel N, Goldstein DJ, Cleveland J, et al. Effect of aspirin dose on hemocompatibility-related outcomes with a magnetically levitated left ventricular assist device: an analysis from the MOMENTUM 3 study. J Heart Lung Transplant. 2020;39(6):518–25.

    Article  Google Scholar 

  16. Latremouille C, et al. A bioprosthetic total artificial heart for end-stage heart failure: results from a pilot study. J Heart Lung Transplant. 2018;37(1):33–7.

    Article  Google Scholar 

  17. Sun W, Jeleniowski K, Zhao X, Shen P, Li D, Hammond JA. Thromboelastography (TEG)-based algorithm reduces blood product utilization in patients undergoing VAD implant. J Card Surg. 2014;29(2):238–43.

    Article  Google Scholar 

  18. Sieg AC, Moretz JD, Horn E, Jennings DL. Pharmacotherapeutic management of gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices. Pharmacotherapy. 2017;37(11):1432–48.

    Article  Google Scholar 

  19. Katz JN, Adamson RM, John R, Tatooles A, Sundareswaran K, Kallel F, et al. Safety of reduced anti-thrombotic strategies in HeartMate II patients: A one-year analysis of the US-TRACE Study. J Heart Lung Transplant. 2015;34(12):1542–8.

    Article  Google Scholar 

  20. Netuka I, Litzler PY, Berchtold-Herz M, Flecher E, Zimpfer D, Damme L, et al. Outcomes in HeartMate II patients with no antiplatelet therapy: 2-year results from the European TRACE study. Ann Thorac Surg. 2017;103(4):1262–8.

    Article  Google Scholar 

  21. Schettle S, Bawardy BA, Asleh R, Sherazi S, Rajan E, Stulak J, et al. Danazol treatment of gastrointestinal bleeding in left ventricular assist device-supported patients. J Heart Lung Transplant. 2018;37(8):1035–7.

    Article  Google Scholar 

  22. Imamura. Omega-3 Therapy Is Associated With Reduced Gastrointestinal Bleeding in Patients With Continuous-Flow Left Ventricular Assist Device. Circ Heart Fail. 2018;11(11):e005082.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Houston BA, Schneider ALC, Vaishnav J, Cromwell DM, Miller PE, Faridi KF, et al. Angiotensin II antagonism is associated with reduced risk for gastrointestinal bleeding caused by arteriovenous malformations in patients with left ventricular assist devices. J Heart Lung Transplant. 2017;36(4):380–5.

    Article  Google Scholar 

  24. Goldstein DJ, John R, Salerno C, Silvestry S, Moazami N, Horstmanshof D, et al. Algorithm for the diagnosis and management of suspected pump thrombus. J Heart Lung Transplant. 2013;32(7):667–70.

    Article  Google Scholar 

  25. Najjar SS, Slaughter MS, Pagani FD, Starling RC, McGee E, Eckman P, et al. An analysis of pump thrombus events in patients in the Heart Ware ADVANCE bridge to transplant and continued access protocol trial. J Heart Lung Transplant. 2014;33(1):23–34.

    Article  Google Scholar 

  26. Oezpeker C, Zittermann A, Ensminger S, Kizner L, Koster A, Sayin A, et al. Systemic thrombolysis versus device exchange for pump thrombosis management: a single-center experience. ASAIO J. 2016;62(3):246–51.

    Article  Google Scholar 

  27. Jennings DL, Weeks PA. Thrombosis in continuous-flow left ventricular assist devices: pathophysiology, prevention, and pharmacologic management. Pharmacotherapy. 2015;35(1):79–98.

    Article  Google Scholar 

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Authors and Affiliations

  1. Cedars Sinai Smidt Heart Institute, 127 S San Vicente Blvd, Los Angeles, CA, 90048, USA

    Robert M. Cole & Lee D. Lam

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  1. Robert M. Cole
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  2. Lee D. Lam
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Correspondence to Robert M. Cole.

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This article is part of the Topical Collection on Thoracic Transplantation

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Cole, R.M., Lam, L.D. Anticoagulation in Mechanical Circulatory Support. Curr Transpl Rep 8, 151–156 (2021). https://doi.org/10.1007/s40472-021-00328-z

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  • DOI: https://doi.org/10.1007/s40472-021-00328-z

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