Antithrombotic Strategies with Left Ventricular Assist Devices.

ABSTRACT

Long-term outcomes of patients with advanced heart failure treated with durable left ventricular assist devices (LVADs) have been augmented due to improved durability and hemocompatibility on the backbone of pump engineering enhancements. The incidence of hemocompatibility-related adverse events (pump thrombosis, stroke and non-surgical bleeding events) are device-specific and vary by type of engineered pump. A fully magnetically levitated rotor containing LVAD in concert with use of antithrombotic therapy has successfully overcome an increased risk of thrombosis albeit with only modest reduction in bleeding events. Modifications to antithrombotic strategies have focused on reduced dose vitamin K antagonist use or use of direct oral anticoagulants with demonstration of safety, and progress in reduction of mucosal bleeding episodes with elimination of antiplatelet agents. This review outlines the current landscape of advances in anticoagulation management in LVAD patients, highlighting the need for ongoing research and cautious application of emerging therapies and technologies.