ArticleJournal of thoracic disease2026
Perioperative anticoagulation management in patients with left ventricular assist devices undergoing elective non-cardiac surgery: a retrospective study of bleeding and thrombosis.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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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.
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Who cites it
1 citing paper in PubMed.
- Fenestrated endovascular aortic repair of a juxtarenal abdominal aortic aneurysm in a patient with a destination left ventricular assist device.Journal of vascular surgery cases and innovative techniques · 2026Article
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6 authors.
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Abstract
Background: Perioperative anticoagulation management for left ventricular assist device (LVAD) recipients undergoing elective non-cardiac surgery (NCS) remains uncertain, particularly in Asian populations. The safety of direct warfarin interruption without heparin bridging in procedures of different bleeding risks is a key knowledge gap. This study aimed to quantify 30-day thrombotic and bleeding outcomes after elective NCS in a predominantly Chinese LVAD cohort and identify predictors of perioperative bleeding. Methods: We conducted a retrospective cohort study of adult LVAD recipients undergoing elective NCS in Hong Kong (May 2020-April 2025). Anticoagulation strategies [warfarin continuation Results: Fifty-five patients (96.4% Chinese; 94.5% male) underwent 85 procedures [HeartMate II (HMII) 12.7%, HeartMate 3 (HM3) 76.4%, HeartWare 10.9%]; mean 2.52±2.0 years from LVAD implantation to NCS. Warfarin was interrupted without bridging in 84.7%, interrupted with bridging in 7.1%, and continued in 8.2%. Thrombotic events occurred in 1/85 (1.2%). Any bleeding (BARC ≥1) occurred in 10.6%; major bleeding (BARC ≥3a) in 8.2% (3.5% BARC 3a; 4.7% BARC 3b). Thirty-day mortality was 1.2% and readmission 8.2%. Predictors of bleeding included higher creatinine (P<0.001), lower haemoglobin (P=0.02), higher alanine aminotransferase (ALT) (P=0.03), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEi/ARB/ARNI) use (P=0.02), and heart failure etiology (P=0.03). Warfarin continuation (P=0.56), LMWH bridging (P=0.12), LVAD type (P=0.48), and procedural bleeding risk (>0.9) were not associated with bleeding. Conclusions: Elective NCS in LVAD recipients under locally lower international normalized ratio (INR) targets showed low thrombotic and acceptable bleeding rates. Direct warfarin interruption without bridging, predominantly for minor/low-risk procedures, appeared safe. Renal dysfunction, anemia, elevated ALT, ACEi/ARB/ARNI use, and heart failure etiology may guide individualized perioperative strategies.
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