Anticoagulation Bridging In Patients With Heartmate3 Left Ventricular Assist Device: A Regional Analysis Of The Momentum 3 Trial

Document Type

Conference Proceeding

Publication Date


Publication Title

J Card Fail


Introduction: Advances in left ventricular assist device (LVAD) technologies have led to a significant improvement in pump hemocompatibility. Due to concerns of thromboembolic complications in older generation LVADs, bridging was commonly performed in patients with subtherapeutic INRs. The effects of this strategy on new generation devices are unclear. We analyzed management strategies of subtherapeutic INRs and their effect on outcomes in a subset of patients enrolled in MOMENTUM 3 trial (CAP and IDE).

Methods: All patients enrolled in the MOMENTUM 3 trial (CAP and IDE) across 6 centers were screened for inclusion. Patients were included if they underwent implantation of an HMIII device and had a subtherapeutic INR following discharge from their admission for LVAD implant. All episodes of subtherapeutic INR underwent manual chart review to evaluate management strategies taken by clinicians. Strategies were divided into two groups, bridging (with parenteral or intravenous agents) or non-bridging (consisting of adjustments or no change in coumadin dosing). The primary outcome was a composite of death, rehospitalization, CVA, and bleeding events.

Results: Of the 225 patients included in the analysis there were total of 235 subtherapeutic INR events. Fifty-six (23.8%) of these INR's were treated with bridging (n= 30 with parenteral agents, n=26 with IV agents) and 179 patients that were not bridged (n=100 coumadin dose adjustment, n=79 no change in coumadin dose). There was no difference in the composite outcome of patients that were bridged compared to those that were not.

Conclusion: Subtherapeutic INR is a common event in patients with HM3 LVAD. The management strategy of subtherapeutic INR varies. Management strategy had no effect on mortality, rehospitalization, CVA, or bleeding events.





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