title: Antiplatelet Therapy and Adverse Hematologic Events During Heart Mate II Support.
abstract: BACKGROUND
  Hematologic adverse events are common during continuous flow left ventricular assist device support; yet, their relation to antiplatelet therapy, including aspirin (ASA) dosing, is uncertain.
  
  
  RESULTS
  A single-center retrospective review of all patients supported by a continuous flow left ventricular assist device (Heart Mate II) from June 2006 to November 2014 was conducted. Patients were categorized into 3 groups: (1) ASA 81 mg+dipyridamole 75 mg daily (n = 26) with a target international normalized ratio (INR) of 2 to 3 from June 2006 to August 2009; (2) ASA 81 mg daily (n = 18) from September 2009 to August 2011 with a target INR of 1.5 to 2; and (3) ASA 325 mg daily from September 2011 to November 2014 with a target INR of 2 to 3 (n = 70). Hemorrhagic and thrombotic outcomes were retrieved ≤ 365 days after implantation. Cumulative survival free from adverse events was calculated using Kaplan-Meier curves and Cox proportional hazard ratios were generated. Hemorrhagic events occurred in 6 patients on ASA 81 mg+dipyridamole (26%; 0.42 events per patient year; mean INR at event, 2.2), 4 patients on ASA 81 mg (22%; 0.38 events per patient year; mean INR at event, 2.0), and in 38 patients on ASA 325 mg (54%; 1.4 events per patient year; mean INR at event, 2.2); P = 0.004. Patients on ASA 325 mg had a higher adjusted hazard ratio of 2.9 (95% confidence interval, 1.2-7.0 versus ASA 81 mg+dipyridamole; P = 0.02) and 3.4 (95% confidence interval, 1.2-9.5 versus ASA 81 mg; P = 0.02) for hemorrhagic events. Thrombotic events rates were not different between groups.
  
  
  CONCLUSIONS
  High-dose ASA in Heart Mate II patients treated concomitantly with warfarin is associated with an increased hazard of bleeding but does not reduce thrombotic events.
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Omar
authors.initials: O
authors.lastname: Saeed
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Aman
authors.initials: A
authors.lastname: Shah
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Faraj
authors.initials: F
authors.lastname: Kargoli
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Shivank
authors.initials: S
authors.lastname: Madan
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Allison P
authors.initials: AP
authors.lastname: Levin
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Snehal R
authors.initials: SR
authors.lastname: Patel
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Rita
authors.initials: R
authors.lastname: Jermyn
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Cesar
authors.initials: C
authors.lastname: Guerrero
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Jenni
authors.initials: J
authors.lastname: Nguyen
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Sims
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Julia
authors.initials: J
authors.lastname: Shin
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: David
authors.initials: D
authors.lastname: D'Alessandro
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Goldstein
authors.affiliation: From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. ujorde@montefiore.org.
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects*; D016009:Chi-Square Distribution; D004176:Dipyridamole / Q000009:adverse effects*; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D015995:Prevalence; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D004176:Dipyridamole; D001241:Aspirin
keywords: aspirin; hemorrhage; international normalized ratio; intracranial hemorrhage; thrombus