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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Shah, Zubair Mastoris, Ioannis Acharya, Prakash Rali, Aniket S. Mohammed, Moghni Sami, Farhad Ranka, Sagar Wagner, Savahanna Zanotti, Giorgio Salerno, Christopher T. Haglund, Nicholas A. Sauer, Andrew J. Ravichandran, Ashwin K. Abicht, Travis |
| Abstract | Background Left ventricular assist devices (LVAD) have been increasingly used in the treatment of end-stage heart failure. While warfarin has been uniformly recommended in the long-term as anticoagulation strategy, no clear recommendation exists for the post-operative period. We sought to evaluate the feasibility of enoxaparin in the immediate and early postoperative period after LVAD implantation. Methods This is a two-center, retrospective analysis of 250 consecutive patients undergoing LVAD implantation between January 2017 and December 2018. Patients were bridged postoperatively to therapeutic INR by either receiving unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were followed while inpatient and for 3 months after LVAD implantation. The efficacy outcome was occurrence of first and subsequent cerebrovascular accident while safety outcome was the occurrence of bleeding events. Length of stay (LOS) was also assessed. Results Two hundred fifty and 246 patients were analyzed for index admission and 3-month follow up respectively. No statistically significant differences were found between the two groups in CVA (OR = 0.67; CI = 0.07–6.39, P = 0.73) or bleeding events (OR = 0.91; CI = 0.27–3.04, P = 0.88) during index admission. Similarly, there were no differences at 3 months in either CVAs or bleeding events (OR = 0.85; 0.31–2.34; p = 0.76). No fatal events occurred during the study follow-up period. Median LOS was significantly lower (4 days; p = 0.03) in the LMWH group. Conclusions LMWH in the immediate and early postoperative period after LVAD implantation appears to be a concurrently safe and efficacious option allowing earlier postoperative discharge and avoidance of recurrent hospitalizations due to sub-therapeutic INR. |
| Related Links | https://cardiothoracicsurgery.biomedcentral.com/counter/pdf/10.1186/s13019-020-01373-y.pdf |
| Ending Page | 8 |
| Page Count | 8 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 17498090 |
| DOI | 10.1186/s13019-020-01373-y |
| Journal | Journal of Cardiothoracic Surgery |
| Issue Number | 1 |
| Volume Number | 15 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2020-11-14 |
| Access Restriction | Open |
| Subject Keyword | Cardiac Surgery Thoracic Surgery Low molecular weight heparin Unfractionated heparin Left ventricular assist device Bridging anticoagulation |
| Content Type | Text |
| Resource Type | Article |
| Subject | Surgery Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine |
| Journal Impact Factor | 1.5/2023 |
| 5-Year Journal Impact Factor | 1.6/2023 |
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