Evaluation of Outpatient Anticoagulation Bridging After Left Ventricular Assist Device Implantation

Objective: The aim of this study is to evaluate the safety of outpatient anticoagulation bridging following left ventricular assist device (LVAD) implantation. Methods: This study is a retrospective, single-center cohort of adult patients who underwent LVAD implantation (HeartMate II™ or HeartMate 3™) and received warfarin and at least one dose of therapeutic enoxaparin or fondaparinux for outpatient anticoagulation bridging. The primary endpoint was the incidence of bleeding complications within one week of completing the bridging episode. Secondary endpoints included the incidence of new hemolysis or thrombosis within 30 days, INR at the time of bridge initiation, duration of anticoagulation bridge, and management of bleeding events associated with the bridging episode. Results: Data from 155 bridging episodes in 44 patients were analyzed. The primary endpoint occurred 30 times during 26 encounters. Of these events, 14 systemic bleeding episodes (9.03%) occurred. Localized bleeding complications consisted of injection site adverse reactions, including bruising (7.74%), bleeding (1.94%), and hematomas (0.65%). The majority of bleeding episodes were successfully self-managed by the patient and required monitoring only (83.33%). Only one new hemolysis event occurred (0.65%) and no new thrombotic events occurred within 30 days of any bridging episode. Conclusion: Results of this study suggest that pharmacist-managed outpatient anticoagulation bridging may be safely initiated in the LVAD patient population, given patients have close follow-up monitoring.