Antithrombotic prophylaxis for thromboembolism in adult patients with a Left Ventricular Assist Device (LVAD): a systematic review update and meta-analysis

Abstract

Abstract

Background: Left Ventricular Assist Device (LVAD) implantation is the treatment of choice in patients with end-stage systolic heart failure awaiting transplantation or ineligible for transplantation, significantly improving survival.12 Recently, the demand for LVADs has been increasing, highlighting the risks of arterial and venous thromboembolism, bleeding and death.13 Prevention of these complications is currently being studied to determine the best antithrombotic prophylactic regimen, particularly comparing mono antithrombotic to dual antithrombotic regimens.14 Methods: We conducted a systematic review and searched Medline, Embase, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1st, 2014 to March 13th, 2022. We identified all studies addressing antithrombotic prophylactic therapy in LVAD patients. The outcomes of interest included thromboembolic complications, mortality, and major bleeding. This systematic review is registered on PROSPERO, registration CRD42021244905. Results: We screened 5,770 references and identified 529 studies on LVAD antithrombotic prophylaxis. A total of 45 studies met eligibility criteria and were extracted. We used the TSA approach to minimize random errors from repeated testing. However, results were inconclusive due to a lack of evidence and high risk of bias in the included studies. Conclusion: To determine the best antithrombotic prophylaxis in LVAD patients, well-conducted non-randomized and randomized controlled trials are needed. Current evidence suggests superiority of dual antithrombotic prophylaxis in the prevention of thromboembolic events and mortality with no difference in bleeding.