Conservative initial postoperative anticoagulation strategy after HeartMate 3 left ventricular assist device implantation

Kevin Damman; Stan A J van den Broek; Gianclaudio Mecozzi; Joep M Droogh; Ethel Metz; Annemieke Oude Lansink; Jan A Krikken; Michiel E Erasmus; Michiel Kuijpers

doi:10.1007/s12471-022-01671-1

Conservative initial postoperative anticoagulation strategy after HeartMate 3 left ventricular assist device implantation

Neth Heart J. 2022 Oct;30(10):466-472. doi: 10.1007/s12471-022-01671-1. Epub 2022 Apr 5.

Authors

Kevin Damman¹, Stan A J van den Broek², Gianclaudio Mecozzi³, Joep M Droogh⁴, Ethel Metz⁴, Annemieke Oude Lansink⁴, Jan A Krikken², Michiel E Erasmus³, Michiel Kuijpers³

Affiliations

¹ Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. k.damman@umcg.nl.
² Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Abstract

Introduction: Although anticoagulation therapy is mandated after implantation of a left ventricular assist device (LVAD), postoperative bleedings and reoperations occur relatively frequently and are associated with worse outcomes. We evaluated the use of a conservative postoperative anticoagulation protocol in patients implanted with a HeartMate 3 (HM3) LVAD.

Methods: In a single-centre retrospective analysis of postoperative outcomes after HM3 LVAD implantation, a standard (old) anticoagulation protocol (i.e. early, full-dose anticoagulation with low-molecular weight heparin and overlapping vitamin K antagonist) was compared with a new conservative anticoagulation protocol (i.e. slow initiation of vitamin K antagonists without overlapping heparin). Main outcomes were changes in international normalised ratio (INR), lactate dehydrogenase (LDH), bleeding and/or tamponade events requiring reoperation, length of stay and adverse events.

Results: In total, 73 patients (48 in old vs 25 in new protocol group) were evaluated. Mean age was 56 years (standard deviation 13) and most patients (78%) were males. Changes in INR and LDH in the first 14 days were similar in both groups (p = 0.50 and p = 0.997 for interaction, respectively). Number of bleeding/tamponade events requiring reoperation was lower in the new than in the old protocol group (4% vs 33%, p = 0.005). Postoperative 30-day mortality was similar, and we observed no thromboembolic events. Median (25th-75th percentiles) total length of postoperative hospital stay (27 (25-41) vs 21 (19-27) days, p < 0.001) and length of intensive care unit stay (5 (2-9) vs 2 (2-5) days, p = 0.022) were significantly shorter in the new protocol group.

Conclusion: These retrospective data suggest that conservative slow initiation of anticoagulation therapy after HM3 LVAD implantation is associated with less bleeding/tamponade events requiring reoperation, a similar safety profile and a shorter duration of stay than the currently advised standard anticoagulation protocol.

Keywords: Anticoagulation; HeartMate 3; LVAD.