PMID- 33189134 OWN - NLM STAT- MEDLINE DCOM- 20210325 LR - 20210415 IS - 1749-8090 (Electronic) IS - 1749-8090 (Linking) VI - 15 IP - 1 DP - 2020 Nov 14 TI - The use of enoxaparin as bridge to therapeutic INR after LVAD implantation. PG - 329 LID - 10.1186/s13019-020-01373-y [doi] LID - 329 AB - BACKGROUND: Left ventricular assist devices (LVAD) have been increasingly used in the treatment of end-stage heart failure. While warfarin has been uniformly recommended in the long-term as anticoagulation strategy, no clear recommendation exists for the post-operative period. We sought to evaluate the feasibility of enoxaparin in the immediate and early postoperative period after LVAD implantation. METHODS: This is a two-center, retrospective analysis of 250 consecutive patients undergoing LVAD implantation between January 2017 and December 2018. Patients were bridged postoperatively to therapeutic INR by either receiving unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were followed while inpatient and for 3 months after LVAD implantation. The efficacy outcome was occurrence of first and subsequent cerebrovascular accident while safety outcome was the occurrence of bleeding events. Length of stay (LOS) was also assessed. RESULTS: Two hundred fifty and 246 patients were analyzed for index admission and 3-month follow up respectively. No statistically significant differences were found between the two groups in CVA (OR = 0.67; CI = 0.07-6.39, P = 0.73) or bleeding events (OR = 0.91; CI = 0.27-3.04, P = 0.88) during index admission. Similarly, there were no differences at 3 months in either CVAs or bleeding events (OR = 0.85; 0.31-2.34; p = 0.76). No fatal events occurred during the study follow-up period. Median LOS was significantly lower (4 days; p = 0.03) in the LMWH group. CONCLUSIONS: LMWH in the immediate and early postoperative period after LVAD implantation appears to be a concurrently safe and efficacious option allowing earlier postoperative discharge and avoidance of recurrent hospitalizations due to sub-therapeutic INR. FAU - Shah, Zubair AU - Shah Z AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Mastoris, Ioannis AU - Mastoris I AUID- ORCID: 0000-0002-1779-6629 AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Acharya, Prakash AU - Acharya P AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Rali, Aniket S AU - Rali AS AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Mohammed, Moghni AU - Mohammed M AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Sami, Farhad AU - Sami F AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Ranka, Sagar AU - Ranka S AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Wagner, Savahanna AU - Wagner S AD - Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA. FAU - Zanotti, Giorgio AU - Zanotti G AD - Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA. FAU - Salerno, Christopher T AU - Salerno CT AD - Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA. FAU - Haglund, Nicholas A AU - Haglund NA AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Sauer, Andrew J AU - Sauer AJ AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular Medicine, Kansas City, Kansas, USA. FAU - Ravichandran, Ashwin K AU - Ravichandran AK AD - Cardiovascular Service Line, Ascension, St. Vincent Hospital, Indianapolis, Indiana, USA. FAU - Abicht, Travis AU - Abicht T AD - University of Kansas Health System, University of Kansas School of Medicine, Department of Cardiovascular and Thoracic Surgery, Kansas City, Kansas, USA. tabicht@kumc.edu. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20201114 PL - England TA - J Cardiothorac Surg JT - Journal of cardiothoracic surgery JID - 101265113 RN - 0 (Anticoagulants) RN - 0 (Enoxaparin) RN - 0 (Heparin, Low-Molecular-Weight) RN - 9005-49-6 (Heparin) SB - IM EIN - J Cardiothorac Surg. 2021 Apr 14;16(1):81. PMID: 33853654 MH - Anticoagulants/administration & dosage/*therapeutic use MH - Drug Administration Schedule MH - Enoxaparin/administration & dosage/*therapeutic use MH - Female MH - Heart Failure/*therapy MH - *Heart-Assist Devices MH - Heparin/administration & dosage/*therapeutic use MH - Heparin, Low-Molecular-Weight/administration & dosage/*therapeutic use MH - Humans MH - Indiana MH - International Normalized Ratio MH - Kansas MH - Male MH - Middle Aged MH - Postoperative Period MH - Retrospective Studies PMC - PMC7666514 OTO - NOTNLM OT - Bridging anticoagulation OT - Left ventricular assist device OT - Low molecular weight heparin OT - Unfractionated heparin COIS- TA serves as a consultant for both Abbott, Inc. (St. Paul, MN) and Medtronic, Inc. (Mounds View, MN). The rest of the authors have nothing to declare with regards to this project. EDAT- 2020/11/16 06:00 MHDA- 2021/03/26 06:00 PMCR- 2020/11/14 CRDT- 2020/11/15 20:18 PHST- 2020/08/19 00:00 [received] PHST- 2020/11/04 00:00 [accepted] PHST- 2020/11/15 20:18 [entrez] PHST- 2020/11/16 06:00 [pubmed] PHST- 2021/03/26 06:00 [medline] PHST- 2020/11/14 00:00 [pmc-release] AID - 10.1186/s13019-020-01373-y [pii] AID - 1373 [pii] AID - 10.1186/s13019-020-01373-y [doi] PST - epublish SO - J Cardiothorac Surg. 2020 Nov 14;15(1):329. doi: 10.1186/s13019-020-01373-y.