Impact of Atrial Fibrillation, Diabetes Mellitus, and Obesity on Outcomes With Aspirin Avoidance and Hemocompatibility With a Left Ventricular Assist Device: An Analysis From the ARIES-HM3 Trial

Q: What is the clinical evidence from this study?

Study design: RCT. Population: HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation. Intervention: Aspirin elimination. Primary outcome: Hemocompatibility-related adverse events.

Q: What does this research mean for the field?

Aspirin elimination in HeartMate 3 LVAD patients maintains its safety profile and bleeding reduction benefit regardless of the presence of atrial fibrillation, diabetes mellitus, or obesity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Nir Uriel; Ivan Netuka; Ulrich P. Jorde; Francis D. Pagani; Jason Neil Katz; Jean M. Connors; Peter Ivák; Daniel Zimpfer; Yuriy Pya; Jennifer L. Conway; Finn Gustafsson; Sriram S. Nathan; Anna Mara Scandroglio; Chris Hayward; David A. D’Alessandro; Morgan E. Collins; Nicholas Dirckx; Mandeep R. Mehra

doi:10.1016/j.cardfail.2025.11.488

Key result

Aspirin elimination consistently reduces bleeding in HM3 LVAD patients across key high-risk comorbidities.

Graphical abstract published by Journal of Cardiac Failure — Graphical abstract · Published by Journal of Cardiac Failure · CC BY-NC-ND 4.0

Why the study?

The impact of atrial fibrillation, diabetes mellitus, and obesity on safety and bleeding outcomes with aspirin elimination after HeartMate 3 LVAD implantation was unclear.

Does aspirin elimination reduce bleeding and maintain safety in HM3 LVAD patients with atrial fibrillation, diabetes mellitus, or obesity?

Study Design

Type

RCT

Structured PICO

Does aspirin elimination reduce bleeding and maintain safety in HM3 LVAD patients with atrial fibrillation, diabetes mellitus, or obesity?

P

Population

Patients implanted with the HM3 LVAD and comorbidities (AF/DM/Ob) from the ARIES-HM3 trial, followed for 1 year.

I

Intervention

Aspirin elimination from the antithrombotic regimen

C

Comparator

Standard antithrombotic regimen (implied aspirin inclusion)

O

Outcome

Hemocompatibility-related adverse events at 1-year postimplantsafety

Aspirin elimination safely reduces bleeding in HM3 LVAD patients regardless of comorbid atrial fibrillation, diabetes mellitus, or obesity.

Implication

Supports aspirin elimination in HM3 LVAD patients with AF, DM, or obesity; extends primary RCT results to these subgroups.

Abstract

BACKGROUND: The ARIES-HM3 trial demonstrated the safety and effectiveness of aspirin elimination from the antithrombotic regimen after HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation. We explored the interaction of atrial fibrillation, diabetes mellitus, and obesity (AF/DM/Ob) with aspirin elimination on hemocompatibility-related adverse events at 1-year postimplant. METHODS: level suppression. RESULTS: levels. CONCLUSION: Among ARIES-HM3 trial patients with AF/DM/Ob, no comorbidity, alone or in combination, altered the safety or observed effect size on bleeding reduction with aspirin elimination in patients implanted with the HM3 LVAD.

Discussion

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Cite This Study

Uriel et al. (2025) conducted an RCT in HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation. Aspirin elimination was evaluated on Hemocompatibility-related adverse events. Aspirin elimination in HM3 LVAD patients maintained its safety and bleeding reduction effect size regardless of the presence of atrial fibrillation, diabetes mellitus, or obesity.

synapsesocial.com/papers/6ab32649dccdd7a5f560d1b9 https://doi.org/10.1016/j.cardfail.2025.11.488