Abstract
Aspirin and warfarin (ASA+W) are used in combination as thromboprophylaxis in patients with Heartmate 3 (HM3) left ventricular assist devices (LVAD). We studied the long-term outcome of aspirin discontinuation in patients with HM3 LVAD. Single-centre study of consecutive patients with HM3 LVAD from October 2015 - July 2019. ASA+W were initiated in all patients after implant. Aspirin was discontinued in patients with bleeding or after 3 months and then maintained on warfarin monotherapy (INR 2-3). Endpoints were a combination of thrombotic (pump thrombosis, stroke or systemic embolism). 90 patients were included. The median duration of HM3 support was 740 (525-1044) days. Aspirin was stopped in 53 patients after median of 126 (77-294) days. Median duration of warfarin monotherapy was 459 (242-718) days. The proportion of patients on warfarin mono therapy increased during follow-up, and 33 patients were maintained on warfarin only for over a year [FIGURE 1]. Mean INR after aspirin discontinuation was 2.2±0.4. There was no pump thrombosis or thromboembolism. Two-year survival for the whole cohort was 82%: 10 died post-implant before discharge, 5 died on support during follow-up (1 from retroperitoneal bleed on ASA+W, 1 right heart failure, 1 malignancy, 1 thyroid storm, 1 died from procedural complication related to nerve block on ASA+W), 1 patient underwent transplantation at 315 days [FIGURE 2}. There were 6 gastrointestinal bleeding episodes in 3 patients on warfarin monotherapy (0.09 events per patient year) but no fatal bleeding. Warfarin monotherapy was not associated with increased risk of thrombosis in patients with HM3 LVAD.
Published Version
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