ReviewHeart failure reviews2025
Evolving anticoagulation paradigms in left ventricular assist device (LVAD) patients: a focus on direct oral anticoagulants.
Review in Heart failure reviews, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Anticoagulation management in patients supported by left ventricular assist devices (LVADs) is essential to prevent thromboembolic events while minimizing bleeding complications. Warfarin remains the standard therapy but is constrained by a narrow therapeutic index, dietary restrictions, and the need for frequent monitoring, prompting growing interest in direct oral anticoagulants (DOACs) as alternatives. The HeartMate 3 (HM3), now the predominant LVAD in clinical practice, features improved hemocompatibility and has demonstrated reduced rates of pump thrombosis and ischemic stroke compared to earlier-generation devices. These advances raise the possibility of simplified antithrombotic regimens tailored to specific device profiles. Retrospective studies suggest that DOACs, particularly apixaban, may provide comparable thromboembolic protection and potentially lower bleeding risk than warfarin, especially when aspirin is omitted. Additionally, DOACs offer more predictable pharmacokinetics, fewer interactions, and improved patient adherence due to reduced monitoring requirements. However, current evidence remains limited by small sample sizes, short follow-up durations, and heterogeneous study designs. Many existing studies include patients with older devices such as HeartMate II and HVAD, which are no longer implanted but remain in a substantial number of living patients. These legacy devices carry distinct thrombogenic risks that complicate generalizability. This review evaluates the emerging role of DOACs in the context of modern and legacy LVAD platforms. While initial data are promising, large-scale, prospective randomized trials are needed particularly in HM3-supported patients to define the optimal anticoagulation strategy.
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