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Purpose Current recommendations for antithrombotic therapy for continuous-flow left ventricular assist device (CF-LVAD) include both anticoagulant and antiplatelet therapy to prevent detrimental thromboembolic (TE) complications. This also results in high incidence of bleeding complications in this population. Several studies have reported favorable outcomes of anticoagulant therapy without antiplatelet therapy to reduce bleeding complications in patients supported with CF-LVADs. Methods We performed a comprehensive literature search through September 2018 using MEDLINE, EMBASE, Scopus and the Cochrane Library. Included studies were prospective or retrospective cohort studies that reported outcomes of CF-LVADs with no antiplatelet therapy. Results Four studies (2 prospective cohort studies, 2 retrospective cohort studies) with 198 patients were included in this study; all patients had Heartmate II devices. Median age was 58 years and 92% were men. All patients received oral vitamin K antagonist for anticoagulation with median INRs of 1.85-2.59. Over median follow-up period of 17 months (range 1-2 years), 5.4% (range 0-7%) had device thrombosis, 4.9% (range 2-7.4%) had ischemic stroke and 21.5% (range 15-37%) had bleeding complications. Hemorrhagic stroke of 4% reported in one study. Conclusion Anticoagulant therapy without antiplatelet therapy in CF-LVAD population may help reduce the incidence of bleeding complications without increasing the risk of TE events. This should be taken into consideration when choosing anticoagulation strategy especially in patients at high risk of bleeding. [ABSTRACT FROM AUTHOR]

Purpose Thromboembolism (TE) is common after left ventricular assist device (LVAD) implantation and early anticoagulation (AC) bridging to therapeutic international normalized ratio (INR) has been widely implemented to prevent this complication. However, some studies suggested that no early AC bridging after LVAD implantation decreases bleeding complications without increase in incidence of TE. This meta-analysis aimed to evaluate the association between early AC bridging after LVAD implantation and incidence of TE and bleeding complications. Methods We performed a comprehensive literature search through September 2018 using MEDLINE and EMBASE. Included studies were prospective or retrospective cohort studies that compared the incidence of TE and bleeding in LVAD patients with and without early AC bridging to therapeutic INR. We calculated pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic using the random-effects model. Results Six studies were included in this meta-analysis. All patients had continuous-flow LVADs implanted. TE events were reported in 6 studies involving 897 patients (611 with bridging, 286 without bridging). Bleeding complications were reported in 4 studies involving 623 patients (405 with bridging, 218 without bridging). Median follow-up was 3.5 months. There was no association between AC bridging and incidence of TE (RR: 0.68; 95% CI: 0.41-1.12, I2 =0%) and bleeding complications (RR: 0.98; 95% CI: 0.61-1.57, I2 =32%) (Figure). Conclusion Our meta-analysis suggests that early AC bridging to therapeutic INR after LVAD implantation is not associated with decreased TE and increased bleeding complications. Controlled trials are warranted to further investigate the utility of early AC bridging after LVAD implantation in patients at high risk for TE complications. [ABSTRACT FROM AUTHOR]