Why the study?
Vitamin K antagonists are the standard thromboprophylaxis for mechanical heart valves and left ventricular assist devices, but hemorrhage remains a primary complication even within the therapeutic range, emphasizing the need for safer alternatives.
Do alternative anticoagulants safely prevent device-induced thrombosis compared to Vitamin K antagonists in patients with mechanical heart valves and LVADs?
Systematic Review
Do alternative anticoagulants safely prevent device-induced thrombosis compared to Vitamin K antagonists in patients with mechanical heart valves and LVADs?
This systematic review evaluates preclinical and clinical data on alternative anticoagulants to Vitamin K antagonists for preventing thrombosis in patients with mechanical heart valves and LVADs.
Insufficient evidence in this source to guide anticoagulant choice for mechanical valves or LVADs; leaves open need for dedicated trials.
The holy grail of anticoagulation in patients with intracardiac devices, such as mechanical heart valves (MHVs) and left ventricular assist devices (LVADs), comprises safe prevention of thrombosis without interrupting normal hemostasis. Device-induced thrombosis and anticoagulant-related bleeding problems are dreaded complications that may cause a significantly reduced quality of life and increased morbidity and mortality. Vitamin K antagonists are the current standard for oral anticoagulation therapy in patients with MHVs and LVADs. Even within the therapeutic range, hemorrhage is the primary complication of these drugs, which emphasizes the need for safer anticoagulants for the prevention of device-induced thrombosis. Device-induced thrombosis is a complex multifactorial phenomenon that likely requires anticoagulant therapy targeting multiple pathways. Here, we review the preclinical and clinical data describing the efficacy of a variety of anticoagulants as thromboprophylaxis after implantation of intracardiac devices.
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Liesdek et al. (2021) conducted a systematic review in Mechanical Heart Valves and Mechanical Circulatory Support Devices. Alternatives for Vitamin K Antagonists vs. Vitamin K Antagonists was evaluated.
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