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Warfarin and Aspirin Versus Warfarin Alone for Prevention of Embolic Events in Patients with a HeartMate II Left Ventricular Assist Device

Van Tuyl, Joseph S.*; Hollis, Ian B.; Alburikan, Khalid A.; Tran, Richard H.§; Murray, Brian P.; Rodgers, Jo E.§; Katz, Jason N.; Sheridan, Brett C.

doi: 10.1097/MAT.0000000000000561
Adult Circulatory Support

Acquired von Willebrand disease increases bleeding risk in patients implanted with a continuous-flow left ventricular assist device. Lower aspirin (ASA) doses decrease the risk of bleeding without an increased risk of embolic events. No published studies in the United States have compared the incidence of bleeding and thrombotic events between antithrombotic regimens with and without ASA. A single-center, retrospective analysis was conducted of adult patients implanted with a HeartMate II (HM II). Patients received warfarin and ASA 81 mg daily or warfarin alone. The primary end-point was a composite of death, bleeding events, and thrombotic events from the date of HM II implantation to first event or 18 months. Secondary end-points included the individual components of the primary end-point and the proportion of patients alive with HM II or transplanted. The Wilcoxon rank sum test and Fisher’s exact test were used for statistical analysis. Of the 76 patients meeting inclusion criteria, 44 received warfarin and ASA and 32 received warfarin alone. Baseline characteristics were similar between groups. Warfarin alone was not associated with an increased risk of the primary composite outcome (53 vs. 59%, respectively, p = 0.64). No significant difference was observed in any bleeding event (34 vs. 43%, respectively, p = 0.48) nor any thrombotic event (9 vs. 11%, respectively, p = 1.00) with warfarin alone compared with warfarin and ASA. Elimination of antiplatelet therapy from the HM II antithrombotic regimen was associated with no significant difference in the composite outcome of bleeding events, thrombotic events, or death, nor the individual components of each end-point.

From the *Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri; Department of Pharmacy, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina; Department of Clinical Pharmacy, King Saud University, Riyadh, Saudi Arabia 11451 KSA; §Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina; Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina; and Department of Surgery, California Pacific Medical Center, San Francisco, California.

Submitted for consideration November 2016; accepted for publication in revised form March 2017.

Disclosures: Jo E. Rodgers, PharmD is a consultant for Novartis, Inc. Brett C. Sheridan, MD is a consultant for St. Jude Medical. Jason N. Katz, MD, MHS receives research support from St. Jude Medical.

Correspondence: Joseph S. Van Tuyl, PharmD, Department of Pharmacy Practice, St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110. Email: Joseph.Vantuyl@stlcop.edu.

Copyright © 2017 by the American Society for Artificial Internal Organs