Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;30(10):466-472.
doi: 10.1007/s12471-022-01671-1. Epub 2022 Apr 5.

Conservative initial postoperative anticoagulation strategy after HeartMate 3 left ventricular assist device implantation

Kevin Damman  1 , Stan A J van den Broek  2 , Gianclaudio Mecozzi  3 , Joep M Droogh  4 , Ethel Metz  4 , Annemieke Oude Lansink  4 , Jan A Krikken  2 , Michiel E Erasmus  3 , Michiel Kuijpers  3
Affiliations

Conservative initial postoperative anticoagulation strategy after HeartMate 3 left ventricular assist device implantation

Kevin Damman et al. Neth Heart J. 2022 Oct.

Abstract

Introduction: Although anticoagulation therapy is mandated after implantation of a left ventricular assist device (LVAD), postoperative bleedings and reoperations occur relatively frequently and are associated with worse outcomes. We evaluated the use of a conservative postoperative anticoagulation protocol in patients implanted with a HeartMate 3 (HM3) LVAD.

Methods: In a single-centre retrospective analysis of postoperative outcomes after HM3 LVAD implantation, a standard (old) anticoagulation protocol (i.e. early, full-dose anticoagulation with low-molecular weight heparin and overlapping vitamin K antagonist) was compared with a new conservative anticoagulation protocol (i.e. slow initiation of vitamin K antagonists without overlapping heparin). Main outcomes were changes in international normalised ratio (INR), lactate dehydrogenase (LDH), bleeding and/or tamponade events requiring reoperation, length of stay and adverse events.

Results: In total, 73 patients (48 in old vs 25 in new protocol group) were evaluated. Mean age was 56 years (standard deviation 13) and most patients (78%) were males. Changes in INR and LDH in the first 14 days were similar in both groups (p = 0.50 and p = 0.997 for interaction, respectively). Number of bleeding/tamponade events requiring reoperation was lower in the new than in the old protocol group (4% vs 33%, p = 0.005). Postoperative 30-day mortality was similar, and we observed no thromboembolic events. Median (25th-75th percentiles) total length of postoperative hospital stay (27 (25-41) vs 21 (19-27) days, p < 0.001) and length of intensive care unit stay (5 (2-9) vs 2 (2-5) days, p = 0.022) were significantly shorter in the new protocol group.

Conclusion: These retrospective data suggest that conservative slow initiation of anticoagulation therapy after HM3 LVAD implantation is associated with less bleeding/tamponade events requiring reoperation, a similar safety profile and a shorter duration of stay than the currently advised standard anticoagulation protocol.

Keywords: Anticoagulation; HeartMate 3; LVAD.

PubMed Disclaimer

Conflict of interest statement

K. Damman has received speaker fees from Abbott. S.A.J. van den Broek, G. Mecozzi, J.M. Droogh, E. Metz, A. Oude Lansink, J.A. Krikken, M.E. Erasmus and M. Kuijpers declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
International normalised ratio (INR) levels after left ventricular assist device (LVAD) implantation in old and new protocol groups. Means and 95% confidence intervals obtained from repeated measures mixed modelling are shown. P-value for interaction type of anticoagulation protocol × time is 0.50. LMWH low molecular-weight heparin
Fig. 2
Fig. 2
Absolute lactate dehydrogenase (LDH) levels over time after left ventricular assist device (LVAD) implantation in old and new protocol groups. Means and 95% confidence intervals obtained from repeated measures mixed modelling are shown. P-value for interaction type of anticoagulation protocol × time is 0.997
Fig. 3
Fig. 3
Kaplan-Meier curves for time to first bleeding/tamponade event requiring reoperation after left ventricular assist device (LVAD) implantation in old and new protocol groups. P-value for log-rank test for difference between anticoagulation protocols is 0.006
See this image and copyright information in PMC

References

    1. Authors/Task Force Members, Document Reviewers 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891–975. doi: 10.1002/ejhf.592. - DOI - PubMed
    1. Truby LK, Rogers JG. Advanced heart failure: Epidemiology, diagnosis, and therapeutic approaches. JACC Heart Fail. 2020;8:523–536. doi: 10.1016/j.jchf.2020.01.014. - DOI - PubMed
    1. Mehra MR, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device—final report. N Engl J Med. 2019;380:1618–1627. doi: 10.1056/NEJMoa1900486. - DOI - PubMed
    1. Netuka I, Ivak P, Tucanova Z, 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;37:579–586. doi: 10.1016/j.healun.2018.03.002. - DOI - PubMed
    1. MCS Working Group Dutch Society of Cardiology/Cardiothoracic Surgery (NVVC/NVT).. www.nvvc.nl/Richtlijnen/Consensus-LVAD-2019-Okt-2019-Final.pdf. Accessed july 1st 2021

LinkOut - more resources