End-stage heart failure is the final stage of heart disease. Patients with end-stage heart failure receive much attention due to their often critical condition. Due to the shortage of donors for heart transplantation, left ventricular assist devices (LVADs) have become an important treatment method to replace the heart’s pumping function. Post-operative bleeding and embolism are among the most common complications after LVAD implantation, seriously threatening the recovery and survival of patients. This article systematically classifies the risk factors of bleeding and embolism into either patient-related, LVAD-related, or exogenous. It analyzes the pathogenic differences of adverse events across different device types,exploring the treatment and prevention of gastrointestinal bleeding, stroke, and pump thrombosis. This article highlights the importance of adjusting anticoagulation regimens, endoscopic interventions, and imaging examinations, as well as preoperative optimization of high-risk patients and management of special clinical scenarios. The development ofthird-generation fully magnetically levitated LVADs make it possible to provide more flexible and precise anticoagulation regimens in clinical practice. Based on the use of unfractionated heparin for bridging in the early postoperative period and long-term administration of warfarin, treatment plans should be adjusted according to different clinical situations to increase the time in therapeutic range and the application of new anticoagulant drugs should be explored to improve the prognosis of LVAD patients, optimizing the anticoagulation strategy in this cohort.
Ning et al. (Thu,) studied this question.
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