Reduced Anticoagulation Strategy with HeartMate 3

Abstract

<h3>Purpose</h3> The use of anticoagulation is the standard of care for management of patients with a Heartmate 3 LVAD (Abbott; Chicago, IL).With the advanced magnetically levitated design of the HM3, there is more flexibility for patients unable to tolerate traditional anticoagulation regimens. We review the clinical outcomes of our single center experience with HM3 patients off anticoagulation or with reduced INR goals. <h3>Methods</h3> All patients implanted at our center with a Heartmate 3 VAD from January 2018 to August 2021 were retrospectively reviewed. Patients off anticoagulation or reduced INR goals were included in this study. <h3>Results</h3> There were a total of 27 patients implanted with a HM3 at our center from 2018-2021 with a mean age 65.4 years, 85.2% (n=23) were male. Thirty-seven percent of patients (n=10) were taken off of anticoagulation entirely or had a reduced INR goal. due to concerns for tolerance of traditional INR goals. Ten percent of these patients (n=1) were not started on any anticoagulation due to severe postoperative bleeding, while 20% (n=2) were stopped within 6 months of VAD implantation and 50% (n=5) stopped within two years due to adverse events. Twenty percent (n=2) of patients had a reduced INR goal of 1.5-2. The most common reason for discontinuation of anticoagulation or reduction of INR goals included persistent gastrointestinal bleeding (40% n=4). Remainder of etiologies included subdural hematoma, noncompliance, and presence of TTR amyloid. Nintey percent (n=9) of patients who were managed off anticoagulation or with reduced INR goals survived greater than one year without clinical signs of device thrombosis or malfunction, including significant fluctuations of device parameters, LDH or echocardiographic abnormalities. Additionally this population remained free from adverse events including stroke or thromboembolism. Sixty percent (n=6) of patients remained event free for 2 years. <h3>Conclusion</h3> THis single center real world retrospective analysis, suggests that, similar to published data, it is reasonable to conclude that HM3 patients canminimal to no anticoagulation without significant adverse events. Patients should continue to have judicious montioring for signs of adverse events and detection of hemolysis and pump thrombosis.