New Advances in Medical Management of Left Ventricular Assist Devices Recipients

The purpose of this review is to discuss medical management of patients with left ventricular assist devices (LVADs) and to summarize recent advancements, specifically focusing on medications for anticoagulation, blood pressure, and heart failure.

Omission of aspirin in LVAD recipients is not associated with an increased risk of pump thrombosis, stroke, or peripheral arterial thromboembolism. Early data from small studies suggest that direct oral anticoagulants can be safely used in patients with the newer generation HeartMate 3 devices. Data supports a mean arterial blood pressure goal of 75-90 mmHg, with avoidance of hypotension. Finally, retrospective studies demonstrate that quadruple guideline-directed medical therapy can be used in patients on LVAD support without an increased risk of adverse events.

Management of LVAD patients is complex, requiring ongoing active decision-making for titration of medications. Larger studies of medical management are needed to further reduce the incidence of gastrointestinal bleeding, right ventricular failure, and increase the potential for myocardial recovery.