Antiplatelet Therapy and Adverse Hematologic Events during Heart Mate II Support

Omar Saeed, Aman Shah, Faraj Kargoli, Shivank Madan, Allison P. Levin, Snehal R. Patel, Rita Jermyn, Cesar Guerrero, Jenni Nguyen, Daniel B. Sims, Jooyoung (Julia) Shin, David D'Alessandro, Daniel J. Goldstein, Ulrich P. Jorde

Research output: Contribution to journalArticle

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Abstract

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. Methods and 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.

Original languageEnglish (US)
JournalCirculation: Heart Failure
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2016

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International Normalized Ratio
Dipyridamole
Therapeutics
Heart-Assist Devices
Confidence Intervals
Warfarin
Aspirin
Disease-Free Survival
Hemorrhage

Keywords

  • Aspirin
  • hemorrhage
  • international normalized ratio
  • intracranial hemorrhage
  • thrombus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Antiplatelet Therapy and Adverse Hematologic Events during Heart Mate II Support. / Saeed, Omar; Shah, Aman; Kargoli, Faraj; Madan, Shivank; Levin, Allison P.; Patel, Snehal R.; Jermyn, Rita; Guerrero, Cesar; Nguyen, Jenni; Sims, Daniel B.; Shin, Jooyoung (Julia); D'Alessandro, David; Goldstein, Daniel J.; Jorde, Ulrich P.

In: Circulation: Heart Failure, Vol. 9, No. 1, 01.01.2016.

Research output: Contribution to journalArticle

Saeed, Omar ; Shah, Aman ; Kargoli, Faraj ; Madan, Shivank ; Levin, Allison P. ; Patel, Snehal R. ; Jermyn, Rita ; Guerrero, Cesar ; Nguyen, Jenni ; Sims, Daniel B. ; Shin, Jooyoung (Julia) ; D'Alessandro, David ; Goldstein, Daniel J. ; Jorde, Ulrich P. / Antiplatelet Therapy and Adverse Hematologic Events during Heart Mate II Support. In: Circulation: Heart Failure. 2016 ; Vol. 9, No. 1.
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AU - Patel, Snehal R.

AU - Jermyn, Rita

AU - Guerrero, Cesar

AU - Nguyen, Jenni

AU - Sims, Daniel B.

AU - Shin, Jooyoung (Julia)

AU - D'Alessandro, David

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N2 - 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. Methods and 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.

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