Discontinuation of antithrombotic therapy for a year or more in patients with continuous-flow left ventricular assist devices

Naveen L. Pereira, Dong Chen, Sudhir S. Kushwaha, Soon J. Park

Research output: Contribution to journalArticle

37 Scopus citations

Abstract

The recommended anticoagulation regimen during continuous-flow axial left ventricular assist device (LVAD) support is aspirin and warfarin with a targeted international normalized ratio of 2.0-3.0. We report two patients in whom recurrent gastrointestinal bleeding during LVAD support necessitated discontinuation of this anti-thrombotic regimen for a year or more. Despite this, neither patients developed thrombotic complications during 29 patient-months of follow-up. An acquired von Willebrand factor (VWF) abnormality reflected by the absence or decreased abundance of the highest molecular weight multimers was demonstrated in both patients. The gold standard test for platelet function, light transmission platelet aggregometry was measured in one patient and was normal, indicative that the predominant abnormality in the coagulation profile of these patients is an acquired VWF syndrome. Clinical trials are required to address the question whether it is safe to discontinue anticoagulation in LVAD patients with acquired VWF abnormalities.

Original languageEnglish (US)
Pages (from-to)503-505
Number of pages3
JournalInteractive cardiovascular and thoracic surgery
Volume11
Issue number4
DOIs
StatePublished - Oct 1 2010

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Keywords

  • Anticoagulation
  • Gastrointestinal bleeding
  • Heart failure
  • Ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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