Use of adenosine diphosphate receptor inhibitor prior to left ventricular assist device implantation is not associated with increased bleeding

Abstract

Current guidelines recommend adenosine diphosphate receptor inhibitors (ADPRi) be discontinued 5-7days prior to cardiac surgery due to increased bleeding events, rates of re-exploration, and transfusions. However, the risks of left ventricular assist device (LVAD) implantation in patients taking an ADPRi have not previously been studied. We retrospectively identified 134 eligible patients with ischemic cardiomyopathy that underwent LVAD implantation between July 2009 and August 2013. The cohorts received an ADPRi ≤5days of surgery (n=25) versus >5days prior or not at all (n=109). Subgroup analyses adjusted for differences in frequency of redo sternotomy between cohorts, excluded patients that received an ADPRi >1year prior to surgery, and excluded patients with a redo sternotomy. The ADPRi and control groups did not have significant differences in the primary outcomes, intraoperative PRBC units transfused (3.0 vs. 4.0, p=0.12) or chest tube output within 24h of surgery (1.66 L vs. 1.80 L, p=0.61). After adjusting for differences in frequency of redo sternotomy (ADPRi vs. control, 12 vs. 52%, p≤0.001), no significant difference in PRBC units transfused (3.1 vs. 3.5, p=0.59) or chest tube output (2.04 L vs. 2.04 L, p=0.98) was seen. No significant difference in 30-day mortality (8.0 vs. 11.0%, p=0.63), 90-day mortality (16.4 vs. 23.3%, p=0.42), or length of stay (29.0 vs. 28.0, p = 0.61) was seen. In this single-center experience, use of an ADPRi ≤5days prior to LVAD implantation was not associated with increased bleeding, length of stay, or mortality.