Outcomes Following Discontinuation of Warfarin in Heartmate 3 Patients: A Multi-Center Review

Bleeding complications during left ventricular assist device (LVAD) support pose anticoagulation challenges as risk of discontinuation of anticoagulation, even in the setting of bleeding, may pose an increased risk of subsequent LVAD hemolysis or thrombosis. We assessed whether discontinuation of anticoagulation in HM3 patients whose bleeding concerns preventing anticoagulation would adversely impact outcomes.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (999) Source Type: research

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LVAD thrombolysis can be effective but carries a bleeding risk. Existing data suggest intraventricular (vs peripheral) delivery may reduce bleeding, but is associated with early recurrence. We have developed a novel hybrid thrombolytic approach (hTL) using an initial high dose LV delivery of alteplase followed by a maintenance LV infusion.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (1004) Source Type: research
Chronic heart failure (CHF) is one of the most severe and adverse diseases of the cardiovascular system, which requires heart transplantation (HT) for patient. Implantation of the left ventricular assist device (LVAD) is the treatment option instead of HT. LVAD can be implanted as a bridge to transplantation and destination therapy (DT). Unfortunately, DT of the LVAD has side effects such as bleeding and thrombosis. These side effects occur because of the non-physiological high shear stress of the LVAD, which causes platelet degradation.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (1003) Source Type: research
Continuous-flow left ventricular assist devices (CFLVAD) in management of end-stage heart failure continues to expand. Adverse events however remain high. Better understanding of platelet activation in the context of CFLVAD therapy may help reduce bleeding and pump thrombosis (PT) risks to patients.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (347) Source Type: research
Left ventricular assist devices (LVAD) are widely used as a support strategy for advanced heart failure. Complications such as thrombosis and bleeding have been linked to LVAD. We observed that LVAD implantation was followed by a sharp increase in serum levels of IgG natural antibodies (Nabs) recognizing oxidation-specific epitopes (OSE) and apoptotic cells. Nabs have been implicated in inflammatory reactions related to atherosclerosis, ischemic stroke and primary graft dysfunction following heart transplantation.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (1211) Source Type: research
Mechanical circulatory support (MCS) has emerged as a lifesaving therapy for patients with advanced and end-stage heart failure. Sadly, MCS therapy is limited by a paradoxical coagulopathy accompanied by both thrombosis and bleeding. We hypothesized that shear-mediated alterations of platelet hemostatic function, i.e. integrin expression, procoagulant activity, and aggregation, mechanistically drive MCS-related coagulopathy.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (420) Source Type: research
The objective of this study was to report incidence and outcomes, including use of anticoagulation and subsequent bleeding rates, of DVT in ECMO-bridged transplant recipients.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (787) Source Type: research
Anticoagulation therapy for patients supported by a left ventricular assist device (LVAD) has not been adequately evaluated in relevance to newer pumps, such as the fully magnetically levitated HeartMate 3 pump. Current anticoagulation guidelines target a goal INR of 2.0 –3.0 with vitamin K antagonists to mitigate the risk of pump thrombosis and ischemic stroke, but are based on historical trials with older devices. Long-term outcomes associated with newer devices, such as the centrifugal-flow HeartMate 3 (HM3), have demonstrated a marked decrease in the incidence of pump thrombosis compared to mechanical bearing axi...
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: Case Anecdotes, Comments and Opinions Source Type: research
Anti-coagulation therapy for patients supported by a left ventricular assist device (LVAD) has not been adequately evaluated in relevance to newer pumps, such as the fully magnetically levitated HeartMate 3 (HM3) pump. Current anti-coagulation guidelines target a goal international normalized ratio (INR) of 2.0 to 3.0, with vitamin K antagonists to mitigate the risk of pump thrombosis and ischemic stroke, but are based on historical trials with older devices. Long-term outcomes associated with newer devices, such as the centrifugal-flow HM3, have demonstrated a marked decrease in the incidence of pump thrombosis compared w...
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: CASE ANECDOTES, COMMENTS AND OPINIONS Source Type: research
Our prior work demonstrated Bleeding and thrombosis events (BTEs) are common in adult patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) but risk factors for these complications are not well understood.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: 57 Source Type: research
The HeartMate 3 Left Ventricular Assist System has demonstrated absence of confirmed de-novo pump thrombosis and reduction in stroke. However, bleeding related adverse events persist under standard anticoagulation targeting a INR range of 2.0-3.0. In an initial experience we demonstrated safety of transition to low intensity anticoagulation (INR target 1.5-1.9, n=15, follow up of at least 6 months). Whether complete cessation of anticoagulation maintains “thromboresistance” in the HeartMate 3 pump remains unknown.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: 254 Source Type: research
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