Perioperative anticoagulation management in patients with left ventricular assist devices undergoing elective non-cardiac surgery: a retrospective study of bleeding and thrombosis
Research article published in Journal of thoracic disease (2026)
Abstract
BACKGROUND: Perioperative anticoagulation management for left ventricular assist device (LVAD) recipients undergoing elective non-cardiac surgery (NCS) remains uncertain, particularly in Asian populations. The safety of direct warfarin interruption without heparin bridging in procedures of different bleeding risks is a key knowledge gap. This study aimed to quantify 30-day thrombotic and bleeding outcomes after elective NCS in a predominantly Chinese LVAD cohort and identify predictors of perioperative bleeding. METHODS: We conducted a retrospective cohort study of adult LVAD recipients undergoing elective NCS in Hong Kong (May 2020-April 2025). Anticoagulation strategies [warfarin continuation vs. interruption with/without low-molecular-weight heparin (LMWH) bridging] and outcomes were collected. Bleeding was classified by Bleeding Academic Research Consortium (BARC). Univariable associations among bleeding and non-bleeding group were tested with t-tests and Chi-squared/Fisher's exact tests. RESULTS: Fifty-five patients (96.4% Chinese; 94.5% male) underwent 85 procedures [HeartMate II (HMII) 12.7%, HeartMate 3 (HM3) 76.4%, HeartWare 10.9%]; mean 2.52±2.0 years from LVAD implantation to NCS. Warfarin was interrupted without bridging in 84.7%, interrupted with bridging in 7.1%, and continued in 8.2%. Thrombotic events occurred in 1/85 (1.2%). Any bleeding (BARC ≥1) occurred in 10.6%; major bleeding (BARC ≥3a) in 8.2% (3.5% BARC 3a; 4.7% BARC 3b). Thirty-day mortality was 1.2% and readmission 8.2%. Predictors of bleeding included higher creatinine (P<0.001), lower haemoglobin (P=0.02), higher alanine aminotransferase (ALT) (P=0.03), angiotensin-converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEi/ARB/ARNI) use (P=0.02), and heart failure etiology (P=0.03). Warfarin continuation (P=0.56), LMWH bridging (P=0.12), LVAD type (P=0.48), and procedural bleeding risk (>0.9) were not associated with bleeding. CONCLUSIONS: Elective NCS in LVAD recipients under locally lower international normalized ratio (INR) targets showed low thrombotic and acceptable bleeding rates. Direct warfarin interruption without bridging, predominantly for minor/low-risk procedures, appeared safe. Renal dysfunction, anemia, elevated ALT, ACEi/ARB/ARNI use, and heart failure etiology may guide individualized perioperative strategies.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Peer-reviewed research on safety and infection-control considerations relevant to leech therapy and anticoagulation. Indexed in PubMed and verified against the NCBI record.
Por qué esto importa para la hirudoterapia
Esta cohorte retrospectiva de 55 receptores de dispositivos de asistencia ventricular izquierda (LVAD), predominantemente chinos, sometidos a 85 procedimientos no cardíacos electivos, encontró que la interrupción directa de warfarin sin puente con heparin (utilizada en el 84,7% de los casos, mayoritariamente en procedimientos menores o de bajo riesgo) se asoció con una baja tasa de trombosis a los 30 días (1,2%) y un sangrado aceptable (10,6% cualquier, 8,2% mayor), surgiendo la disfunción renal, la anemia, la ALT elevada, el uso de ACEi/ARB/ARNI y la etiología por insuficiencia cardíaca como predictores de sangrado en lugar de la estrategia de anticoagulación en sí misma. Para ASH, esto refuerza el tema perioperatorio central: el manejo de pacientes anticoagulados sistémicamente que se someten a cirugía es fundamentalmente un acto de equilibrio entre el sangrado y la trombosis, la misma ecuación relevante cuando se consideran las sanguijuelas medicinales, que añaden un efecto anticoagulante local, en pacientes quirúrgicos, y resalta los factores de riesgo de sangrado impulsados por comorbilidades que un equipo debería señalar. La advertencia es que se trata de una cohorte retrospectiva pequeña y de una sola región en una población de LVAD muy específica sin participación de sanguijuelas; sus hallazgos son específicos de la población y exploratorios respecto a los predictores, y sirve únicamente como contexto de anticoagulación, no como evidencia a favor o en contra de la hirudoterapia.
Citación
Perioperative anticoagulation management in patients with left ventricular assist devices undergoing elective non-cardiac surgery: a retrospective study of bleeding and thrombosis.
Lam et al. · Journal of thoracic disease, 2026
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026