PMID- 33741791
OWN - NLM
STAT- MEDLINE
DCOM- 20211213
LR  - 20230927
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 67
IP  - 12
DP  - 2021 Dec 1
TI  - Unfractionated and Low-Molecular-Weight Heparin for Bridging Patients with Left 
      Ventricular Assist Device: An Event-Based Analysis.
PG  - 1277-1283
LID - 10.1097/MAT.0000000000001392 [doi]
AB  - The relative efficacy of bridging with low-molecular-weight heparin (LMWH) or 
      unfractionated heparin (UFH) in left ventricular assist device (LVAD) patients 
      has not been established. We performed a retrospective, longitudinal cohort study 
      to evaluate safety and efficacy of bridging strategies including all adult LVAD 
      patients implanted at the Medical University of South Carolina from August 2014 
      to July 2017. In addition to LMWH and UFH exposure, we recorded any time period a 
      patient did not receive a bridging agent for a subtherapeutic international 
      normalized ratio (INR) value as a control group; these events were defined as 
      nonbridging (NB) events. Multivariable Cox regression survival models were 
      utilized for analysis. There were 563 episodes evaluated in 50 patients. Compared 
      with NB events, UFH (adjusted hazard ratio [aHR], 3.75; 95% CI, 1.45-9.73; p = 
      0.007) and LMWH (aHR, 2.25; 95% CI, 1.03-4.94; p = 0.043) were both associated 
      with an increased risk of bleeding. Compared with NB events, LMWH was not 
      associated with a decreased risk of clotting events (aHR, 1.56; 95% CI, 
      0.28-8.73; p = 0.616). In the 381 NB events, a nonsignificant signal was noted 
      toward increased risk of thrombotic events in those with an INR </= 1.5 (aHR, 2.99; 
      95% CI, 0.57-15.8; p = 0.2). Among all 563 episodes, those with a baseline INR >/= 
      2.0 demonstrated an increased risk of bleeding events (aHR, 2.35; 95% CI, 
      1.18-5.69; p = 0.016). Our data suggest that the efficacy of LMWH bridging in 
      LVAD patients warrants further investigation.
CI  - Copyright (c) ASAIO 2021.
FAU - Rabon, Alyssa D
AU  - Rabon AD
AD  - From the Department of Pharmacy Services, Oregon Health and Science University, 
      Portland, Oregon.
FAU - Taber, David J
AU  - Taber DJ
AD  - Department of Surgery, Medical University of South Carolina, Charleston, South 
      Carolina.
FAU - Uber, Walter E
AU  - Uber WE
AD  - Department of Pharmacy Services, Medical University of South Carolina, 
      Charleston, South Carolina.
FAU - Houston, Brian A
AU  - Houston BA
AUID- ORCID: 0000-0001-6188-8072
AD  - Division of Cardiology, Medical University of South Carolina, Charleston, South 
      Carolina.
FAU - Meadows, Holly
AU  - Meadows H
AD  - Department of Pharmacy Services, Medical University of South Carolina, 
      Charleston, South Carolina.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/adverse effects
MH  - *Heart-Assist Devices/adverse effects
MH  - Heparin
MH  - *Heparin, Low-Molecular-Weight/adverse effects
MH  - Humans
MH  - Longitudinal Studies
MH  - Retrospective Studies
COIS- Disclosure: The authors have no conflicts of interest to report.
EDAT- 2021/03/21 06:00
MHDA- 2021/12/15 06:00
CRDT- 2021/03/20 06:07
PHST- 2021/03/21 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2021/03/20 06:07 [entrez]
AID - 00002480-202112000-00002 [pii]
AID - 10.1097/MAT.0000000000001392 [doi]
PST - ppublish
SO  - ASAIO J. 2021 Dec 1;67(12):1277-1283. doi: 10.1097/MAT.0000000000001392.