Abstract 17337: The Effect of Digoxin on Hemocompatibility Related Adverse Events in Patients With Durable Left Ventricular Assist Devices

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isabel Balachandran ◽  
Kevin Kennedy ◽  
Jose Nunez ◽  
Wilson Grandin ◽  
Arthur R Garan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Significant Difference ◽  
Left Ventricular Assist

Introduction: Hemocompatibility-related adverse events (HRAE) including stroke, pump thrombosis, and gastrointestinal bleeding (GIB), is a major cause of mortality in patients with continuous flow left ventricular assist devices (CF-LVAD). Digoxin (dig) is used in treatment of advanced heart failure, and has been implicated in decreasing angiogenesis via HIF-alpha/TGF inhibition. There is conflicting data regarding the effect of dig on GIB rates in patients with cf-LVADs. We investigated the association of dig use in patients implanted with CF-LVADs with HRAE with both centrifugal and axial flow devices. Methods: 12,002 patients from the INTERMACS registry implanted with cf-LVADs between 2012-2017 and were alive at 1-month were included. The event rates of HRAE at 1-yr post implant were compared in patients with or without dig use at 1-month post implant. Cox proportional hazards modeling was used to assess the independent association of dig use and HRAE. Results: There was no significant difference in age, sex, race, Cr, INR, DM, and AST in those who were prescribed vs. not prescribed dig at 1 month. On univariate analysis, dig was associated with decreased HRAE in patients with CF-LVADs at 1-year post implantation (37% vs 41%, p<0.01) (Fig. 1) however this was primarily driven by decreased neurologic events. There was no association with GIB (p 0.18). On multivariate analysis, dig was not found to be an independent predictor of HRAE (HR 0.95, 95% CI 0.89-1.02, p 0.2) (Figure 2). Conclusions: Despite previous smaller studies which suggested a decreased risk of HRAE and GIB in patients with cf-LVADs, we found that dig was not an independent predictor of HRAE.

Left Ventricular Assist Devices in Patients with Transposition of the Great Arteries: Survival and Adverse Events

2020 ◽  
Vol 26 (10) ◽  
pp. S154
Author(s):  
Shaundeep Sekhon ◽  
Eriberto Michel ◽  
Tingqing Wu ◽  
Rebecca Harap ◽  
Faraz S. Ahmad ◽  
...  
Keyword(s):  
Adverse Events ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Left Ventricular Assist

P1667Comparison of post-implant anticoagulation agents in left ventricular assist devices

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bigeh ◽  
J Keuth ◽  
R Gerkin ◽  
R Gopalan
Keyword(s):  
Adverse Events ◽  
Medical Center ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Heparin Group ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Anticoagulation Agents ◽  
Left Ventricular Assist

Abstract Background Left ventricular assist devices (LVADs) improve survival in patients with end-stage heart failure. Despite technological advancements, there is still a high risk of bleeding and thromboembolic events. To minimise device clotting, anticoagulation is usually started three days after implant. Unfractionated heparin (UFH) is the standard as a bridge to coumadin, however, current guidelines lack comparative evidence and do not delineate between anticoagulation agents (such as enoxaparin). Purpose To evaluate the safety of post-implant anticoagulation in LVAD patients using UFH and low molecular weight heparin enoxaparin (LMWH). Methods From October 2007 to October 2018, 83 patients underwent LVAD implantation (Heartmate II, III or HVAD) at Banner University Medical Center-Phoenix. Retrospective analysis was performed on 68 patients who received post-implant anticoagulation with a goal INR 1.8–2.5. Patients were bridged with either UFH (n=46) or LMWH (n=22). Results Demographics and patient characteristics were comparable between groups. We analysed adverse events, survival, and time to adverse events. The heparin group had a nonsignificant longer event-free period after implant compared with LMWH, median 9.4 and 1.8 months, respectively (p=0.428). The LMWH group had a significantly increased proportion of adverse events across all categories (p=0.021). Bleeding was the most common event for both groups, although substantially more for those receiving LMWH. Most notably 14 heparin patients (30.4%) had no adverse events compared to zero in the LMWH group. Types of Adverse Events Post-Implant Bleeding Hemorrhagic Stroke Ischemic Stroke Pump Thrombus None Total Bridging Agent Heparin Count 18 3 8 3 14 46 % 39.1% 6.5% 17.4% 6.5% 30.4% 100% Enoxaparin Count 14 2 4 2 0 22 % 63.6% 9.1% 18.2% 9.1% 0% 100% Total Count 32 5 12 5 14 68 % 47.1% 7.4% 17.6% 7.4% 20.6% 100% p=0.021. Post-Implant Event-Free Survival Conclusions Minimising bleeding and clotting are a persistent challenge in LVAD patients. Use of LMWH was associated with significantly more adverse events compared to UFH, with bleeding constituting the majority of events. Establishing institutional protocols and standards are necessary to improve patient outcomes; therefore, larger prospective studies are needed.

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