Warfarin anticoagulation in patients with axillary intra-aortic balloon pumps.

Background: Intra-aortic balloon pumps (IABPs) are associated with thrombotic complications, including limb ischemia and device thrombosis. As a result, parenteral anticoagulation with unfractionated heparin is commonly used to mitigate thrombotic risk. However, continuous intravenous anticoagulation increases fluid exposure, requires central venous access and frequent monitoring, and may limit patient mobility. Warfarin represents a potential oral alternative for patients requiring prolonged axillary IABP support. Objective: To describe the use and clinical outcomes of warfarin anticoagulation in patients with surgically placed axillary IABPs. Methods: Single-center retrospective chart review of adult patients admitted to the cardiac care unit who received anticoagulation with warfarin while supported with a surgically placed axillary IABP. The primary endpoint was the composite occurrence of bleeding or thrombotic events during warfarin therapy. Secondary endpoints included time in therapeutic range, need for pump exchange, escalation to alternative mechanical circulatory support, and unplanned IABP removal. Results: A total of 47 patients were included. Median duration of IABP support and warfarin therapy was 34 and 27 days, respectively. Minor bleeding occurred in 11 patients (23.4%), while venous thrombotic events occurred in 6 patients (12.8%). The average INR at the time of bleeding events was 1.7, while the average INR at the time of thrombotic events was 1.8. No major bleeding, ischemic stroke, or limb ischemia was observed. Conclusion and Relevance: In this cohort of patients with axillary IABPs receiving warfarin anticoagulation, the observed rates of major bleeding and clinically significant thrombotic complications were low. These findings describe the outcomes of warfarin use in patients requiring prolonged axillary IABP support and provide context for anticoagulation practices in this population.