Abstract 15728: Apixaban Use in Patients Supported by Durable Left Ventricular Assist Device

Abstract

Introduction: Coumadin is currently the standard of care for long-term anticoagulation in patients supported with a left ventricular assist device (LVAD). Coumadin requires frequent testing and is associated with adverse events. The aim of this study was to evaluate the routine use of Apixaban in contemporary LVAD patients. Methods: A single center LVAD database was retrospectively queried to identify HeartMate 3 (HM3) patients between January 2016 and May 2022. Patients were divided into 2 groups based on anticoagulation received: Coumadin vs Apixaban. The primary outcome was 1-year mortality and secondary events of freedom from bleeding and stroke at 1 year. Univariate statistics and Kaplan-Meier curves were used for data analysis. Results: A total of 67 consecutive patients underwent HM3 implant during the study period: 20 (30%) coumadin and 47 (70%) apixaban. There was no difference in gender, age, BMI, creatinine, previous stroke or INTERMACS level between groups (Tabe1). Total days of support: Coumadin 25,750 days and Apixaban 16,556 days. The mortality at one year was comparable (5% v. 6%, p=0.12). The coumadin group had higher overall bleeding events (55% v. 17%, p<.01) and freedom bleeding at 1 year was better in apixaban group (86% v. 64%, p=0.04). Freedom from stroke at 1 year was comparable between the groups (95% v. 97%, p=026). Survival at 1 year with no stroke or bleeding was similar (Figure 1). Conclusion: In this single center retrospective analysis, Apixaban in patients with a durable LVAD has shown reduced bleeding events and comparable stroke and survival outcomes. This early experience demonstrates that Apixaban is a possible alternative to Coumadin.