Fine lines and thin margins: Nutritional and anticoagulation challenges in long-term mechanical circulatory support

Introduction: Patients receiving long-term mechanical circulatory support (MCS), including Left Ventricular Assist Device (LVAD) and total artificial heart (TAH), represent a high-risk population prone to thromboembolic and bleeding complications. Stable anticoagulation is essential, as even minor INR fluctuations may result in severe consequences. Warfarin and acenocoumarol require consistent vitamin K intake and careful monitoring of food interactions, herbal supplements, and fruit juices.Methodology: This article is based on review and synthesis of relevant published studies, clinical guidelines, and expert recommendations.Topic: A stable and predictable intake of vitamin K reduces INR variability, while sudden dietary changes increase the risk of bleeding or thrombosis. Herbal supplements and spices - such as garlic, ginger, turmeric, Ginkgo biloba, as well as alcohol, and certain fruit juices (e.g. grapefruit, cranberry) may destabilize INR. Patient education, individualized nutritional planning, and multidisciplinary supervision are essential to maintain anticoagulation stability.Conclusion: Consistent vitamin K intake, careful management of supplements and spices, patient education, and coordinated multidisciplinary supervision contribute to stable anticoagulation, reduce complication risks, and improve quality of life in patients with long-term MCS.