Do you need anticoagulation with LVAD?
LVAD patients require life-long anticoagulant therapy to reduce the risk of pump thrombosis. However, exposing LVAD patients to anticoagulant therapy, in combination with common acquired coagulopathies after LVAD implantation such as acquired von Willebrand syndrome, comes with high risks of bleeding.
Which is a contraindication for VAD placement?
Absolute contraindications include systemic illness with a life expectancy of less than 2 years or malignancy within 5 years, irreversible renal or hepatic dysfunction, severe obstructive pulmonary disease, or other systemic disease with multiorgan involvement (27).
Which medical condition may impede blood flow through the pump and is still treated for patients with an LVAD?
Mitral stenosis (MS) impedes LVAD filling by restricting blood flow into the LV; this must be rectified via bioprosthetic mitral valve replacement or mitral commissurotomy. Mechanical valves are not used as they require a higher INR goal than VADs alone and may lead to increased risk of bleeding and/or thrombosis.
When to use antiplatelet vs anticoagulant?
Anticoagulants slow down clotting, thereby reducing fibrin formation and preventing clots from forming and growing. Antiplatelet agents prevent platelets from clumping and also prevent clots from forming and growing.
Are LVAD patients on blood thinners?
You will need to be on blood thinners and most likely an aspirin for as long as you have your LVAD.
What are the indications for LVAD?
Indications and Device Type.
Is warfarin an antiplatelet?
There are different types of blood thinners: Anticoagulants, such as heparin or warfarin (also called Coumadin), slow down your body’s process of making clots. Antiplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets from clumping together to form a clot.
What is the standard anticoagulation after LVAD implantation?
Following LVAD implantation, patients are started on standard anticoagulation with warfarin to maintain an INR of 2.0–3.0 without IV UFH bridge and aspirin 325 mg a day. Thrombotic complications often occur in the setting of lowering anticoagulation for a bleeding event 19 .
What are anticoagulation protocols?
Anticoagulation protocols are both device type and institution specific but rely on a combination of aspirin, from 81 to 325 mg a day, and warfarin, in patients with continuous flow devices.
What is the goal International Normalized Ratio for warfarin therapy for LVAD?
The goal international normalized ratio for warfarin therapy varies from 1.5 to 3.0. Some physicians manage adult LVAD patients without antiplatelet medication, whereas other adults are treated with aspirin as a single agent or combined with dipyridamole.
Who will present the anticoagulation therapy for left ventricular thrombus webinar?
Anticoagulation Therapy for Left Ventricular Thrombus Webinar Presenters Arthur Allen, PharmD, CACP • Anticoagulation Program Manager, VA Salt Lake City Health Care System Geoffrey Barnes, MD, MSc • Assistant Professor of Internal Medicine, Vascular and Cardiovascular Medicine, University of Michigan Tracy Minichiello, MD