Direct Oral Anticoagulants Versus Warfarin in Adults With Durable Left Ventricular Assist Devices: A Systematic Review and Meta-Analysis.

Authors

Mohammed Mhanna
Mohammed Ayyad
Ibrahim Mortada
Ahmad Al-Abdouh
Ahmad Jabri, Corewell Health
Abdulmajeed Al-Harbi
Mahmoud Barbarawi
Azizullah Beran
Ernesto Ruiz Duque
Shareef Mansour

Document Type

Article

Publication Date

12-2024

Publication Title

Current Problems in Cardiology

Abstract

INTRODUCTION: The management of anticoagulation in patients with durable left ventricular assist devices (LVADs) is challenging. Traditionally, warfarin has been used, but its limitations have prompted interest in direct oral anticoagulants (DOACs). This meta-analysis aims to evaluate the safety and efficacy of DOACs compared to warfarin in LVAD patients.

METHODS: We searched databases for studies comparing DOACs and warfarin in LVAD patients. Primary outcomes were thromboembolic events and major bleeding events. Secondary outcomes were the individual components of the thromboembolic events, minor bleeding events, and all-cause mortality. Random-effects model was used to calculate log risk-ratios (RR) with 95 % confidence intervals (CI).

RESULTS: Nine studies with a total of 316 LVAD patients (153 on DOACs, 163 on warfarin) were included. Thromboembolic events were similar between the groups (Log RR -0.42, 95 % CI:1.29 to 0.45, P = 0.34). Major bleeding events were significantly fewer in the DOAC group (Log RR -1.05, 95 % CI:1.73 to -0.36, P < 0.01). Minor bleeding events were also less common with DOACs (Log RR -0.77, 95 % CI:1.46 to -0.07, P = 0.03). No significant differences were observed in pump thrombosis, ischemic cerebrovascular accident events, or all-cause mortality.

CONCLUSION: DOACs appear to be a safe and effective alternative to warfarin for anticoagulation in LVAD patients, associated with fewer major and minor bleeding events. These findings support the consideration of DOACs in this patient population, though further research is needed to confirm these results and guide clinical practice.

Volume

49

Issue

12

First Page

102871

Recommended Citation

Mhanna M, Ayyad M, Mortada I, Al-Abdouh A, Jabri A, Al-Harbi A, et al. Direct oral anticoagulants versus warfarin in adults with durable left ventricular assist devices: a systematic review and meta-analysis. Curr Probl Cardiol. 2024 Dec;49(12):102871. doi: 10.1016/j.cpcardiol.2024.102871. PMID: 39369772.

DOI

10.1016/j.cpcardiol.2024.102871

ISSN

1535-6280

PubMed ID

39369772