Hiruy Aklil, Anderson Keith, Bhattacharya Sanjeeb, Lee Ran, Williams James B
Department of Pharmacy Services, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Artif Organs. 2024 Apr;48(4):386-391. doi: 10.1111/aor.14684. Epub 2023 Nov 21.
Patients with left ventricular assist devices (LVADs) require systemic anticoagulation. The use of enoxaparin for bridging to warfarin remains understudied in this population.
This single-center retrospective study was performed to characterize enoxaparin use and associated thrombotic and bleeding outcomes in adult outpatients with LVADs from January 2018 to July 2021.
Fifty-four enoxaparin bridging events were evaluated in 49 patients. Most patients with HeartMate II (HM2) and HeartWare (HVAD) devices received enoxaparin dosed 1 mg/kg every 12 h. In patients with HeartMate 3 (HM3) devices, an equal number of patients received 0.5 mg/kg every 12 h and 1 mg/kg every 12 h, with a smaller subset receiving intermediate doses. The median duration of bridging was 6 days (4-8 [IQR]). One major bleeding event required discontinuation of enoxaparin and hospitalization in a patient with an HM3 device. Thrombotic events occurred in four patients with two incidents of pump thrombosis requiring pump exchange and two ischemic strokes. All thrombotic events occurred in patients with HVAD or HM2 devices.
These results suggest that enoxaparin bridging in LVAD patients was well-tolerated with low bleeding and thrombotic rates, particularly with the HM3 device.
植入左心室辅助装置（LVAD）的患者需要进行全身抗凝治疗。在这一人群中，使用依诺肝素桥接至华法林的情况仍未得到充分研究。
本单中心回顾性研究旨在描述2018年1月至2021年7月期间成年LVAD门诊患者使用依诺肝素的情况以及相关的血栓形成和出血结局。
对49例患者的54次依诺肝素桥接事件进行了评估。大多数使用HeartMate II（HM2）和HeartWare（HVAD）装置的患者接受每12小时1mg/kg剂量的依诺肝素。在使用HeartMate 3（HM3）装置的患者中，接受每12小时0.5mg/kg和每12小时1mg/kg剂量的患者数量相等，还有一小部分患者接受中间剂量。桥接的中位持续时间为6天（4-8[四分位间距]）。1例主要出血事件导致1例使用HM3装置的患者停用依诺肝素并住院治疗。4例患者发生血栓形成事件，其中2例泵血栓形成事件需要更换泵，2例发生缺血性卒中。所有血栓形成事件均发生在使用HVAD或HM2装置的患者中。
这些结果表明，LVAD患者使用依诺肝素桥接耐受性良好，出血和血栓形成率较低，尤其是使用HM3装置时。
