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Novel Oral Anticoagulants in Patients with Continuous Flow Left Ventricular Assist Devices
The gold standard for anticoagulation in patients with continuous flow left ventricular assist device (CF-LVADs) is warfarin. However, many patients fail warfarin therapy due to thromboembolic and bleeding events. Warfarin requires regular monitoring and dosage adjustments, and is associated with significant patient time outside recommended therapeutic INR range. Novel oral anticoagulation (NOAC) has been shown to be non-inferior compared to warfarin in stroke prevention with less intracranial hemorrhage in patients with atrial fibrillation.
Source: The Journal of Heart and Lung Transplantation - March 16, 2019 Category: Transplant Surgery Authors: V. Parikh, U. Parikh, A.M. Ramirez, H. Lamba, J. George, S. Fedson, F. Cheema, A. Civitello, A. Nair, A. Shafii, G. Loor, T. Rosengart, O. Frazier, J. Morgan, R. Delgado Tags: 1072 Source Type: research

Managing Anticoagulation in LVAD Patients: The Harefield Experience
Anticoagulation management in patients with Left Ventricular Assist devices (LVAD) continues to be a challenge. Patients and their clinicians are faced with the daily challenge of needing adequate anticoagulation versus the bleeding risks that are associated with anticoagulation.Warfarin is the recommended oral anticoagulant for all currently available LVAD devices.Warfarin is known to be a difficult medication to manage due to its narrow therapeutic window, and its many interactions .Dlott et al (2014) describe in Circulation the overall time in therapeutic range for patients on warfarin as 53.7%, Time in therapeutic rang...
Source: The Journal of Heart and Lung Transplantation - March 25, 2017 Category: Transplant Surgery Authors: R. Hards, G. Edwards, C. Kavanagh, M. Hedger, A.R. Simon Source Type: research

Atrial fibrillation in dialysis patients: time to abandon warfarin?
Abstract Atrial fibrillation (AF) is a frequent clinical complication in dialysis patients, and warfarin therapy represents the most common approach for reducing the risk of stroke in this population. However, current evidence based on observational studies, offer conflicting results, whereas no randomized controlled trials have been carried out so far. Additionally, many clinicians are wary of the possible role of warfarin as vascular calcification inducer and its potential to increase the high risk of bleeding among patients on dialysis. Ideally the most promising therapy would be based on direct inhibitors of f...
Source: The International Journal of Artificial Organs - April 8, 2016 Category: Transplant Surgery Authors: Brancaccio D, Neri L, Bellocchio F, Barbieri C, Amato C, Mari F, Canaud B, Stuard S Tags: Int J Artif Organs Source Type: research

Gastrointestinal bleeding and subsequent risk of thromboembolic events during support with a left ventricular assist device
Background: Modern left ventricular assist devices (LVAD) require anti-coagulation (AC) with warfarin and anti-platelet therapy to prevent thromboembolic complications in patients. Gastrointestinal bleeding (GI) is a significant adverse event in these patients and treatment typically requires reduction or elimination of AC or anti-platelet therapy. It is not known whether alterations in AC to treat GI bleeding influence subsequent risk of thromboembolic (TE) events during LVAD support.Methods: Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous-flow LVAD at the University of...
Source: The Journal of Heart and Lung Transplantation - September 9, 2013 Category: Transplant Surgery Authors: John M. Stulak, Dustin Lee, Jonathon W. Haft, Matthew A. Romano, Jennifer A. Cowger, Soon J. Park, Keith D. Aaronson, Francis D. Pagani Tags: Featured Articles Source Type: research