ReviewInteractive cardiovascular and thoracic surgery2012
What is the optimal anticoagulation in patients with a left ventricular assist device?
Review in Interactive cardiovascular and thoracic surgery, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 79 citations in OpenAlex.
- Advancements in left ventricular assist devices to prevent pump thrombosis and blood coagulopathy.Journal of anatomy · 2023Review
- Left Ventricular Assist Device Thrombosis: Combined Approach by Echocardiography and Logfiles Review for Diagnosis and Management.Brazilian journal of cardiovascular surgery · 2022Article
- Left Ventricular Assist Device Pump Thrombosis in a Patient Treated with Apixaban.The American journal of case reports · 2021Article
- Prothrombin Complex Concentrate for Emergent Reversal of Intracranial Hemorrhage in Patients with Ventricular Assist Devices.Neurocritical care · 2021Article
- Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: a joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI).European heart journal. Cardiovascular pharmacotherapy · 2021Article
- Clinical Approach to Manage Gastrointestinal Bleeding with a Left Ventricular Assist Device (LVAD).Cureus · 2019Review
- Device-induced platelet dysfunction in mechanically assisted circulation increases the risks of thrombosis and bleeding.Artificial organs · 2019Article
- An introduction to point-of-care testing in extracorporeal circulation and LVADs.Hematology. American Society of Hematology. Education Program · 2018Review
- Antithrombotic therapy in ventricular assist device (VAD) management: From ancient beliefs to updated evidence. A narrative review.International journal of cardiology. Heart & vasculature · 2018Review
- Management of epistaxis in patients with ventricular assist device: a retrospective review.Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale · 2018Article
- Routine clinical anti-platelet agents have limited efficacy in modulating hypershear-mediated platelet activation associated with mechanical circulatory support.Thrombosis research · 2018Article
- Improving anticoagulation of patients with an implantable left ventricular assist device.BMJ open quality · 2018Article
- Heparin induced thrombocytopenia with mechanical circulatory support devices: review of the literature and management considerations.Journal of thrombosis and thrombolysis · 2017Review
- Thrombolytics in VAD management - A single-center experience.International journal of cardiology. Heart & vasculature · 2016Article
- Use of Heparin in Acute Ischemic Stroke: Is There Still a Role?Current atherosclerosis reports · 2015Review
- [Intensive care treatment of patients with left ventricular assist devices].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2015Review
- Covering implantable left ventricular assist device (DuraHeart) with free flap.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2015Article
- [Patients with implanted ventricular assist devices : Challenge for emergency medicine].Der Anaesthesist · 2015Review
- [Noncardiological surgical procedure for patients implanted with a ventricular assist device. Anesthesiological management concepts].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2015Review
- Complications of Continuous-Flow Mechanical Circulatory Support Devices.Clinical Medicine Insights. Cardiology · 2015Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether there is an optimal antithrombotic management for patients supported with axial-flow left ventricular assist devices (LVADs). Altogether, more than 758 papers were found using the reported search, of which 17 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. These included seven prospective and three retrospective cohort studies with a total of 538 patients with axial-flow left ventricular assist device (LVAD) (HeartMate II, Jarvik 2000, INCOR, Thoratec assist device) implanted across the world as destination therapy or bridge to transplantation. We conclude that there is a substantial alteration of the prothrombotic profile in patients with axial-flow LVADs. These abnormalities appeared to be reversible with the removal of the device and are likely to be responsible for the high incidence of non-surgical bleeding episodes reported. Warfarin seems to offer a lower thromboembolic risk compared with unfractioned heparin or low molecular weight heparin. There are reports that suggest that managing axial-flow LVAD without anticoagulation, after major bleeding complications, is possible but in all probability, these papers are subject to publication bias as poor outcomes are unlikely to have been reported. All patients with axial-flow LVAD, showed severely impaired platelet function at point of care tests. The use of warfarin (INR target 2.5), in association with aspirin at 100 mg/day, or with point-of-care tests titrated antiplatelet therapy to inhibit 70%, seems to have the best bleeding-thrombosis, and in many cases a very small dose of aspirin of 25 mg twice a day and a dose of clopidogrel of 35 mg/day, were sufficient to achieve a reduction of the maximum aggregation to less than 30%. Finally, we would like to emphasize that such recommendations are addressed only to patients with axial-flow LVAD.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.