title: Safety of anticoagulation reversal in patients supported with continuous-flow left ventricular assist devices.
abstract: The purpose of this study was to characterize the potential thromboembolic risk associated with the reversal of warfarin-based anticoagulation in patients with continuous-flow left ventricular assist devices (CF-LVADs). All patients implanted with a CF-LVAD between January 1, 2008, and August 1, 2012, at our institution were screened, and those who received anticoagulation reversal during an inpatient admission were enrolled. The primary outcome is the incidence of thrombotic events, including stroke, device thrombosis, or venous thromboembolism within 30 days of anticoagulation reversal. Of the 122 patients screened, 25 patients experienced 38 anticoagulation reversal events. All patients received vitamin K at a mean dose of 10 ± 8 mg, while 60% of patients received fresh frozen plasma. Only two patients received prothombin complex concentration and three patients received activated factor VII. The rate of thromboembolism within 30 days of attempted reversal was 2.6% (1/38). This patient developed an ischemic stroke after reversal with a high dose of activated factor VII for an acute intracranial bleed. The mortality rate within 30 days of reversal was 20% (5/25), with three of these deaths associated with acute intracranial hemorrhage. Anticoagulation reversal may be safely attempted in selected patients under CF-LVAD support.
authors.affiliation: From the *Department of Pharmacy Practice, Nova Southeastern University, Ft. Lauderdale, Florida; †Wayne State University, Detroit, Michigan; ‡Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan; §Department of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan; and ¶Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Jennings
authors.forename: Minu
authors.initials: M
authors.lastname: Jacob
authors.forename: Anuvrat
authors.initials: A
authors.lastname: Chopra
authors.forename: Carrie W
authors.initials: CW
authors.lastname: Nemerovski
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin