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Management of Antiplatelet Therapy During Continuous-Flow Left Ventricular Assist Device Support After Thrombotic Hemorrhagic Events

Gallo, Michele*; Trivedi, Jaimin R.*; Mondal, Nandan K.*,‡; Birks, Emma J.; Slaughter, Mark S.*

doi: 10.1097/MAT.0000000000000935
Adult Circulatory Support
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Hemorrhagic or thrombotic events are common complications in heart failure patients with continuous-flow left ventricular assist device (CF-LVAD) support. Aim of this study is to investigate the effect of change in antiplatelet therapy after thrombotic or hemorrhagic events in patients with CF-LVAD support. A total of 231 CF-LVAD patients were included in this study. Patients with CF-LVAD were categorized into three groups: (1) high antiplatelet regimen as control group (aspirin [ASA] 325 mg; n = 115), (2) low antiplatelet regimen (ASA 81 mg; n = 82), started after hemorrhagic complications, and (3) double antiplatelet therapy (ASA/clopidogrel; n = 34) started after thrombotic complications. In our analysis, indications for low antiplatelet therapy were gastrointestinal (GI) bleeding (36%), hemorrhagic stroke (8%), and epistaxis (9%). Freedom from major bleeding events after changing therapy was comparable at 1 year for all three groups respectively 96%, 97%, and 91% (log rank = 0.421). Major indications for double antiplatelet therapy were pump thrombosis (15%) and coronary artery stent placement (2.5%). Freedom from thrombotic events after changing therapy was comparable at 1 year for groups 1, 2, and 3, respectively, 97%, 98%, and 91% (log rank = 0.317). Logistic regression shows that Heartmate II patients required more antiplatelet therapy changes compared with HeartWare (odds ratio [OR]: 3.611, 95% confidence interval [CI]: 1.8–6.9; p = 0.0001). HeartMate II required more adjustment of antiplatelet therapy during follow-up. Reducing or increasing antithrombotic therapies in response to major thrombotic hemorrhagic events in CF-LVAD patients is a safe strategy to avoid recurrences.

From the *Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky

Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, Kentucky

Division of Cardiothoracic Transplantation and Circulatory support, Michael E. DeBakey Department of Sugery, Baylor College of Medicine, Texas Heart Institute.

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Submitted for consideration June 2018; accepted for publication in revised form November 2018.

Disclosure: The authors have no conflicts of interest to report.

This manuscript was presented at the annual International Society for Heart and Lung Transplantation meeting; April 2017; San Diego, CA.

Correspondence: Mark S. Slaughter, Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202. Email: mark.slaughter@louisville.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs