The Journal of Heart and Lung Transplantation
Volume 29, Issue 6 , Pages 616-624, June 2010

Post-operative heparin may not be required for transitioning patients with a HeartMate II left ventricular assist system to long-term warfarin therapy

  • Mark S. Slaughter, MD

      Affiliations

    • Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky
    • Corresponding Author InformationReprint requests: Mark S. Slaughter, MD, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202. Telephone: 502-561-2180. Fax: 502-561-2190
    • ,
  • Yoshifumi Naka, MD

      Affiliations

    • Department of Surgery and the Cardiac Transplantation and Mechanical Circulatory Support Programs, Columbia University, New York, New York
    • ,
  • Ranjit John, MD

      Affiliations

    • Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota
    • ,
  • Andrew Boyle, MD

      Affiliations

    • Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
    • ,
  • John V. Conte, MD

      Affiliations

    • Division of Surgery, Johns Hopkins University, Baltimore, Maryland
    • ,
  • Stuart D. Russell, MD

      Affiliations

    • Division of Cardiology and the Heart Failure and Transplantation Program, Johns Hopkins University, Baltimore, Maryland
    • ,
  • Keith D. Aaronson, MD

      Affiliations

    • Department of Internal Medicine and the Heart Failure Program, University of Michigan, Ann Arbor, Michigan
    • ,
  • Kartik S. Sundareswaran, PhD

      Affiliations

    • Thoratec Corporation, Pleasanton, California
    • ,
  • David J. Farrar, PhD

      Affiliations

    • Thoratec Corporation, Pleasanton, California
    • ,
  • Francis D. Pagani, MD, PhD

      Affiliations

    • Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan

published online 20 April 2010.

Background

Anti-coagulation with heparin is often used after left ventricular assist device implantation as a transition to long-term warfarin therapy. We retrospectively evaluated the effects of heparin use on thromboembolic and bleeding complications after implantation of the HeartMate II left ventricular assist device (LVAD).

Methods

LVAD patients (n = 418) implanted as a bridge to transplant were divided into three groups: Group A patients (therapeutic, n = 118) received heparin and had a partial thromboplastin time (PTT) of >50 seconds on two or more occasions; Group B patients (sub-therapeutic, n = 178) had at least one PTT value in the range of 40 to 55 seconds; and Group C patients (no heparin, n = 122) had no PTT values >40 seconds. All patients were transitioned to warfarin and aspirin therapy. The following adverse events were evaluated: ischemic stroke; hemorrhagic stroke; pump thrombosis; bleeding requiring surgery; and bleeding requiring ≥2 units of packed red blood cells in 24 hours.

Results

There was no difference in the percentages of patients with ischemic (5%, 4%, 3%) or hemorrhagic (3%, 3%, 5%) strokes or pump thrombosis (3%, 2%, 2%) after post-operative day (POD) 3 among Groups A, B and C, respectively. From PODs 3 to 30, the percentage of patients requiring transfusion for bleeding was significantly lower for Group C (18%) than for Groups A (32%) and B (26%) (p = 0.04); differences after 30 days were not significant. Multivariate analysis revealed that post-operative heparin use, low post-operative platelet count and low baseline hematocrit value were independent risk factors for bleeding events between PODs 3 and 30.

Conclusions

In patients receiving the HeartMate II LVAD who were directly transitioned to warfarin and aspirin therapy without intravenous heparin there was no short-term increase in risk of thrombotic or thromboembolic events, and bleeding requiring transfusion was significantly reduced. Additional long-term follow-up is needed to evaluate possible late effects.

Keywords: HeartMate II, LVAD, heparin, anticoagulation management, thrombosis

 

PII: S1053-2498(10)00074-4

doi:10.1016/j.healun.2010.02.003

The Journal of Heart and Lung Transplantation
Volume 29, Issue 6 , Pages 616-624, June 2010

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