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Impact of time off anticoagulation in patients with continuous-flow left ventricular assist devices

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  • Artificial Heart (Clinical)
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Abstract

Patients with left ventricular assist devices (LVADs) receive anticoagulation to decrease the risk of thrombosis. Various circumstances require discontinuing anticoagulation in LVAD patients, but the risks entailed are not well defined. In a retrospective review of LVAD implantation procedures, we examined the effect of time off anticoagulation on thrombosis and mortality rates after implantation. An international normalized ratio ≤ 1.5 was used to screen for patients taken off anticoagulation. Patients were divided into three groups by the cumulative number of days off anticoagulation: no discontinuation, short-term discontinuation (< 30 days), and long-term discontinuation (≥ 30 days). Rates of ischemic stroke, pump thrombosis, and mortality were compared among groups. Of 245 patients who underwent LVAD implantation during the study, 70 (28.6%) were off anticoagulation during follow-up: 37 (15.1%) had short-term discontinuation (median, 11 days), and 33 (13.5%) had long-term discontinuation (median, 124 days). Patients with long-term discontinuation had a higher rate of ischemic stroke (adjusted hazard ratio 8.5, p = 0.001) and death (adjusted hazard ratio 3.9, p = 0.001). The three groups did not differ in pump thrombosis rate. We conclude that after LVAD implantation, discontinuing anticoagulation for ≥ 30 days is independently associated with an increased risk of ischemic stroke and death.

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Acknowledgements

The authors gratefully acknowledge Stephen N. Palmer. PhD, ELS, of the Department of Scientific Publications at the Texas Heart Institute for his editorial assistance.

Funding

We did not receive any funding for this study.

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Authors and Affiliations

  1. Department of Medicine, Baylor College of Medicine, McNair Campus (MCHA) A10.193 MS: BCM903, 7200 Cambridge Street, Houston, TX, 77040, USA

    Christian A. Inchaustegui, Ashley Patel, Andrew Brown, Justin Arunthamakun & Kevin Ting

  2. Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Harveen K. Lamba, Alexis E. Shafii, Kenneth K. Liao & Andrew B. Civitello

  3. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Subhasis Chatterjee & Alexis E. Shafii

  4. Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Subhasis Chatterjee

  5. Texas Heart Institute, Houston, TX, USA

    Subhasis Chatterjee, Joggy K. George & Andrew B. Civitello

  6. Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Ajith P. Nair, Joggy K. George & Andrew B. Civitello

  7. Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA

    Christian A. Inchaustegui

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  1. Christian A. Inchaustegui
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  2. Ashley Patel
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Correspondence to Christian A. Inchaustegui or Harveen K. Lamba.

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Some of the materials herein were presented as a poster at the 2019 American Heart Association Scientific Sessions, Philadelphia, PA, November 16–18, 2019.

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Inchaustegui, C.A., Patel, A., Lamba, H.K. et al. Impact of time off anticoagulation in patients with continuous-flow left ventricular assist devices. J Artif Organs 26, 275–286 (2023). https://doi.org/10.1007/s10047-022-01367-8

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  • DOI: https://doi.org/10.1007/s10047-022-01367-8

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