Key result
Bridging with parenteral anticoagulants for subtherapeutic INRs in HeartMate 3 recipients resulted in no difference in death, rehospitalization, CVA, or bleeding compared with nonbridging.
Why the study?
Given improved hemocompatibility with newer left ventricular assist devices, management strategies for subtherapeutic INRs and their effects on current-generation devices needed review.
Does bridging with parenteral anticoagulants improve outcomes in HeartMate 3 LVAD recipients with subtherapeutic INRs compared to a nonbridging strategy?
Observational (n=225)
Yes
Does bridging with parenteral anticoagulants improve outcomes in HeartMate 3 LVAD recipients with subtherapeutic INRs compared to a nonbridging strategy?
In HeartMate 3 LVAD recipients with subtherapeutic INRs, bridging with parenteral anticoagulants does not appear to improve clinical outcomes compared to nonbridging strategies.
Bridging subtherapeutic INRs showed no outcome difference versus nonbridging in HM3 patients; leaves open optimal management strategies.
Advances in left ventricular assist device technologies have led to an improvement in pump hemocompatibility and outcomes. Because of concerns of thromboembolic complications in prior generations of left ventricular assist devices, bridging with parenteral anticoagulants was routinely. Management strategies of subtherapeutic INRs and their effects on the current generation of devices deserve review. We performed analysis of the MOMENTUM 3 trial including 6 centers in the mid-America region. Patients with subtherapeutic INRs (INR < 2) occurring after the index admission underwent chart review to determine the management strategies taken by clinicians. Strategies were divided into two groups, bridging or nonbridging. Of the 225 patients included in the analysis, 130 (58%) patients had a total of 235 subtherapeutic international normalized ratio (INR) events. Most (n = 179, 76.2%) of these INRs were not bridged (n = 100 warfarin dose adjustment, n = 79 no change in warfarin dose). Among those INRs (n = 56, 23.8%) treated with bridging, approximately half (n = 30, 53.6%) were treated with subcutaneous agents and other half (n = 26, 46.4%) were treated with intravenous agents. There was no difference in individual outcomes or composite endpoints of death, rehospitalization, CVA, or bleeding events between the groups.
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Yaranov et al. (2023) conducted an observational in Left Ventricular Assist Device (HeartMate 3) recipients with subtherapeutic INRs (n=225). Bridging with parenteral anticoagulants vs. Nonbridging (warfarin dose adjustment or no change) was evaluated on Composite of death, rehospitalization, CVA, or bleeding events. Bridging with parenteral anticoagulants for subtherapeutic INRs in HeartMate 3 recipients resulted in no difference in death, rehospitalization, CVA, or bleeding compared with nonbridging.
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