Outcomes in Patients with a Centrifugal Flow with Full Magnetic Levitation Left Ventricular Assist Device (CF-FML LVAD) Who Did Not Receive Bridging with a Continuous Heparin Infusion (CHI) After Implantation

Abstract

PurposeCompare outcomes in CF-FML LVAD patients who received a CHI after implantation until they reached a therapeutic INR on warfarin to patients who were started on warfarin only and did not receive a CHI.MethodsA retrospective analysis using chart review and the institutional LVAD database was completed on 27 patients.Results5 of the 27 patients did not receive a CHI after implantation of CF-FML LVAD (due to a medication shortage), they were started on warfarin post-operative day 1 or 2 (POD1 or POD2) for an INR goal of 2-3. CHI was initiated on the remaining patients (DOS-POD8) and PTT reached therapeutic range POD2 (DOS-POD9). 2 patients did not reach therapeutic PTT before their INR was therapeutic. The CHI patients were started on warfarin POD4 (DOS-POD14). INR was therapeutic for patients without CHI POD6 (POD5-POD11). INR was therapeutic for patients with CHI POD10 (POD2-POD31). The no CHI patients reached therapeutic INR faster and were discharged from index hospitalization sooner. The no CHI patients had similar or less adverse events (AEs) then the CHI patients (Image 1).ConclusionIn a small cohort of patients, initiation of warfarin anticoagulation without CHI was not associated with thromboembolic complications. Further work to identify populations of LVAD supported patients who need less anticoagulation post-operatively is warranted before considering practice changes. Compare outcomes in CF-FML LVAD patients who received a CHI after implantation until they reached a therapeutic INR on warfarin to patients who were started on warfarin only and did not receive a CHI. A retrospective analysis using chart review and the institutional LVAD database was completed on 27 patients. 5 of the 27 patients did not receive a CHI after implantation of CF-FML LVAD (due to a medication shortage), they were started on warfarin post-operative day 1 or 2 (POD1 or POD2) for an INR goal of 2-3. CHI was initiated on the remaining patients (DOS-POD8) and PTT reached therapeutic range POD2 (DOS-POD9). 2 patients did not reach therapeutic PTT before their INR was therapeutic. The CHI patients were started on warfarin POD4 (DOS-POD14). INR was therapeutic for patients without CHI POD6 (POD5-POD11). INR was therapeutic for patients with CHI POD10 (POD2-POD31). The no CHI patients reached therapeutic INR faster and were discharged from index hospitalization sooner. The no CHI patients had similar or less adverse events (AEs) then the CHI patients (Image 1). In a small cohort of patients, initiation of warfarin anticoagulation without CHI was not associated with thromboembolic complications. Further work to identify populations of LVAD supported patients who need less anticoagulation post-operatively is warranted before considering practice changes.