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Anticoagulation strategies for left ventricular assist devices

Toeg, Hadia; Ruel, Marca; Haddad, Haissamb

Current Opinion in Cardiology: March 2015 - Volume 30 - Issue 2 - p 192–196
doi: 10.1097/HCO.0000000000000143
HEART FAILURE: Edited by Haissam Haddad

Purpose of review Pump thrombosis can be a devastating complication in patients with a left ventricular assist device (LVAD). Treatment options with intravenous anticoagulation can lead to further complications. The present review discusses the current antithrombotic and anticoagulation strategies following LVAD implantation and during suspected pump thrombosis.

Recent findings Recently, a significant increase in pump thrombosis (HeartMate II) at 3 months after LVAD implantation starting in March 2011 has been observed. This observation is likely multifaceted; however, recent changes in perioperative anticoagulation, accepting lower target international normalized ratios and lack of heparin bridging may play a substantial role. The International Society for Heart and Lung Transplantation published guidelines surrounding LVAD anticoagulation and management options in the setting of pump thrombosis.

Summary Recommendations for thromboprophylaxis in patients with LVADs are scarce. The International Society for Heart and Lung Transplantation has put together minimum criteria for perioperative anticoagulation; however, this is on the basis of poor level of evidence (observational studies and expert opinion). Ultimately, clinicians will need to individualize the intensity and timing of anticoagulation following LVAD implantation to ensure adequate thromboprophylaxis while simultaneously minimizing bleeding.

aDivision of Cardiac Surgery

bDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Correspondence to Dr Haissam Haddad, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada. Tel: +1 613 761 5165; fax: +1 613 761 5212; e-mail: HHaddad@ottawaheart.ca

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