Anticoagulation for Durable Mechanical Circulatory Support

Anticoagulation is necessary for patients with left ventricular assist devices (LVADs) to decrease the risk of device thrombosis and systemic embolization, but it must be carefully balanced with the risks of bleeding that can cause significant morbidity and mortality. Anticoagulation for LVAD implantation should be tailored to each patient’s needs. When rotary blood pumps were first introduced into clinical practice, preventing pump thrombosis was a major concern. As a result, a combination of platelet inhibition and anticoagulation using Vitamin K antagonists was recommended. Currently, there have been some significant changes in LVAD therapy, most notably with the introduction of the HeartMate 3 device which has a low incidence of pump thrombosis. The evaluation of anemia and thrombocytopenia is crucial prior to LVAD implantation. The coagulation management for LVAD placement adheres to guidelines and hospital-based protocols for open heart surgery. In the immediate postoperative period, it is important to closely monitor chest tube output, hemoglobin/hematocrit levels, and coagulation status. The management of warfarin therapy for patients with mechanical circulatory support can be challenging due to multiple drug interactions and the patient’s nutritional status. Outpatient programs that focus on patient education, INR home monitoring devices, and INR clinics can help achieve tight INR control.