Klosko Rachel C, Whitson Bryan, Lampert Brent, McLaughlin Eric, Orzel Libby
Department of Pharmacy Practice, Binghamton University School of Pharmacy and Pharmaceutical Sciences, Johnson City, New York, USA.
Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Artif Organs. 2025 Apr;49(4):639-648. doi: 10.1111/aor.14908. Epub 2024 Nov 27.
The objective of this study is to determine the incidence of major bleeding events in patients implanted with continuous flow left ventricular assist devices (CF-LVADs) bridged with enoxaparin (LMWH) compared to intravenous unfractionated heparin (IV UFH) for a subtherapeutic INR on warfarin.
A single-center, retrospective, cohort study was conducted including patients with CF-LVADs implanted between January 1, 2012 and July 1, 2020 who received at least one inpatient dose or outpatient prescription for LMWH or IV UFH at least 60 days after CF-LVAD implantation. The primary endpoint was the incidence of major bleeding.
In total, 176 orders were screened and 90 orders in 62 unique patients were included. Major bleeding and thromboembolic events occurred in 1 (2.5%) versus 4 (10.0%) orders (p = 0.36) and 3 (7.5%) versus 1 (2.5%) orders (p = 0.62) in the LMWH and IV UFH groups, respectively. One patient had a fatal thromboembolic event in each group. More patients receiving IV UFH had minor bleeding events (10 [25.0%] vs. 3 [7.5%]; p = 0.03).
There was no difference between bleeding and thromboembolic events in patients implanted with CF-LVADs prescribed LMWH or IV UFH for bridging of subtherapeutic INRs. Larger prospective randomized data are needed to validate these findings.
本研究的目的是确定与静脉注射普通肝素（IV UFH）相比，接受依诺肝素（LMWH）桥接治疗华法林诱导的亚治疗性国际标准化比值（INR）的持续血流左心室辅助装置（CF-LVAD）植入患者的大出血事件发生率。
进行了一项单中心、回顾性队列研究，纳入2012年1月1日至2020年7月1日期间植入CF-LVAD且在CF-LVAD植入后至少60天接受过至少一剂住院剂量或门诊处方LMWH或IV UFH的患者。主要终点是大出血的发生率。
共筛选了176份医嘱，纳入了62例独特患者的90份医嘱。LMWH组和IV UFH组分别有1例（2.5%）和4例（10.0%）医嘱发生大出血事件（p = 0.36），3例（7.5%）和1例（2.5%）医嘱发生血栓栓塞事件（p = 0.62）。每组各有1例患者发生致命性血栓栓塞事件。接受IV UFH的患者发生轻微出血事件的更多（10例[25.0%]对3例[7.5%]；p = 0.03）。
接受LMWH或IV UFH桥接治疗亚治疗性INR的CF-LVAD植入患者在出血和血栓栓塞事件方面没有差异。需要更大规模的前瞻性随机数据来验证这些发现。
