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Hamostaseologie 2025; 45(01): 080-088
DOI: 10.1055/a-2487-6365
Review Article

Antithrombotic Treatment for Left Ventricular Assist Devices: One Does Not Fit All

Emmanuelle Scala 
1   Department of Anaesthesiology, Cardiothoracic and Vascular Anaesthesia, Lausanne University Hospital (CHUV), Lausanne, Switzerland
2   Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
,
Alexandra Othenin-Girard 
1   Department of Anaesthesiology, Cardiothoracic and Vascular Anaesthesia, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Abstract

As the prevalence of heart failure is increasing globally, left ventricular assist devices (LVADs) have become essential therapeutic options in managing advanced heart failure. This review explores the development of LVAD technology, with a focus on the shift from pulsatile to continuous-flow devices, particularly the HeartMate 3, the most advanced generation of LVADs. The evolution in design has significantly enhanced patient survival and quality of life. However, hemocompatibility-related adverse events (HRAEs)—such as pump thrombosis, ischemic and hemorrhagic strokes, and gastrointestinal bleeding—remain major clinical challenges. Striking the delicate balance between preventing thromboembolic events and minimizing hemorrhagic risks remains critical in LVAD patient management. Current therapeutic strategies typically involve long-term anticoagulation with vitamin K antagonists and antiplatelet therapy, though optimal management must be individualized based on patient-specific factors and device characteristics. Emerging alternatives, including low-dose anticoagulation, direct oral anticoagulants such as apixaban, and aspirin-free regimens, offer promising potential to reduce adverse outcomes. This review also highlights the role of innovative mechanical designs in minimizing shear stress and alternative treatments in preventing complications like gastrointestinal bleeding. Despite these advancements, personalized treatment strategies are critical, as no single therapeutic regimen fits all LVAD recipients. Ongoing research into both device technology and pharmacological therapies is essential to further reduce HRAEs and improve long-term outcomes for LVAD patients.

Keywords

left ventricular assist device - hemocompatibility-related adverse event - antithrombotic treatment - antiplatelet therapy


Publication History

Received: 16 October 2024

Accepted: 25 November 2024

Article published online:
19 February 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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