Key result
Discontinuation of antithrombotic therapy for a year or more in two LVAD patients with acquired von Willebrand factor abnormalities resulted in 0 thrombotic complications over 29 patient-months.
Why the study?
The safety of discontinuing anticoagulation in continuous-flow LVAD patients with acquired von Willebrand factor abnormalities is uncertain.
Does discontinuation of antithrombotic therapy prevent recurrent GI bleeding without increasing thrombotic complications in LVAD patients with acquired VWF abnormalities?
Case Report (n=2)
Does discontinuation of antithrombotic therapy prevent recurrent GI bleeding without increasing thrombotic complications in LVAD patients with acquired VWF abnormalities?
Discontinuation of antithrombotic therapy in LVAD patients with recurrent GI bleeding and acquired VWF abnormalities may be feasible without thrombotic complications, warranting further clinical trials.
The recommended anticoagulation regimen during continuous-flow axial left ventricular assist device (LVAD) support is aspirin and warfarin with a targeted international normalized ratio of 2.0-3.0. We report two patients in whom recurrent gastrointestinal bleeding during LVAD support necessitated discontinuation of this anti-thrombotic regimen for a year or more. Despite this, neither patients developed thrombotic complications during 29 patient-months of follow-up. An acquired von Willebrand factor (VWF) abnormality reflected by the absence or decreased abundance of the highest molecular weight multimers was demonstrated in both patients. The gold standard test for platelet function, light transmission platelet aggregometry was measured in one patient and was normal, indicative that the predominant abnormality in the coagulation profile of these patients is an acquired VWF syndrome. Clinical trials are required to address the question whether it is safe to discontinue anticoagulation in LVAD patients with acquired VWF abnormalities.
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Pereira et al. (2010) conducted a case report in Continuous-flow left ventricular assist device (LVAD) support (n=2). Discontinuation of antithrombotic therapy was evaluated on Thrombotic complications. Discontinuation of antithrombotic therapy for a year or more in two LVAD patients with acquired von Willebrand factor abnormalities resulted in 0 thrombotic complications over 29 patient-months.
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