Fondaparinux as an Alternative Anticoagulant Treatment in Patients with Left Ventricular Assist Devices and Recurrent Gastrointestinal Bleeding: Case Series

Abstract

Gastrointestinal bleeding (GIB) can occur in patients after left ventricular assist device (LVAD) implantation. In cases of recurrent GIB, the management of anticoagulation treatment represents a challenging situation in which the risk of bleeding recurrence and the need for long-term anticoagulation must be balanced. This case series describes the successful management of anticoagulation in three patients with recurrent GIB using fondaparinux. To our knowledge, these are the first reported cases of recurrent GIB in which a single dose of subcutaneous fondaparinux was used instead of oral anticoagulation. None of the patients presented with signs of pump thrombosis or arterial embolism. If confirmed by larger studies, the substitution of oral anticoagulation with subcutaneous, single-dose fondaparinux could represent a safe alternative treatment in a select group of patients with recurrent GIB.