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Use of adenosine diphosphate receptor inhibitor prior to left ventricular assist device implantation is not associated with increased bleeding

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  • Artificial Heart (Clinical)
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Abstract

Current guidelines recommend adenosine diphosphate receptor inhibitors (ADPRi) be discontinued 5–7 days prior to cardiac surgery due to increased bleeding events, rates of re-exploration, and transfusions. However, the risks of left ventricular assist device (LVAD) implantation in patients taking an ADPRi have not previously been studied. We retrospectively identified 134 eligible patients with ischemic cardiomyopathy that underwent LVAD implantation between July 2009 and August 2013. The cohorts received an ADPRi ≤5 days of surgery (n = 25) versus >5 days prior or not at all (n = 109). Subgroup analyses adjusted for differences in frequency of redo sternotomy between cohorts, excluded patients that received an ADPRi >1 year prior to surgery, and excluded patients with a redo sternotomy. The ADPRi and control groups did not have significant differences in the primary outcomes, intraoperative PRBC units transfused (3.0 vs. 4.0, p = 0.12) or chest tube output within 24 h of surgery (1.66 L vs. 1.80 L, p = 0.61). After adjusting for differences in frequency of redo sternotomy (ADPRi vs. control, 12 vs. 52%, p ≤ 0.001), no significant difference in PRBC units transfused (3.1 vs. 3.5, p = 0.59) or chest tube output (2.04 L vs. 2.04 L, p = 0.98) was seen. No significant difference in 30-day mortality (8.0 vs. 11.0%, p = 0.63), 90-day mortality (16.4 vs. 23.3%, p = 0.42), or length of stay (29.0 vs. 28.0, p = 0.61) was seen. In this single-center experience, use of an ADPRi ≤5 days prior to LVAD implantation was not associated with increased bleeding, length of stay, or mortality.

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Authors and Affiliations

  1. Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Anjan Tibrewala & Adam Andruska

  2. Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA

    Michael E. Nassif, Jerrica E. Shuster, Eric Novak, Justin M. Vader, Gregory A. Ewald & Shane J. LaRue

  3. Division of Cardiothoracic Surgery, Washington University School of Medicine, Campus Box 8234, 660 S Euclid Avenue, St. Louis, MO, 63110, USA

    Scott Silvestry & Akinobu Itoh

Authors
  1. Anjan Tibrewala
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  2. Michael E. Nassif
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  3. Adam Andruska
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  4. Jerrica E. Shuster
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  5. Eric Novak
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  6. Justin M. Vader
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  7. Gregory A. Ewald
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  8. Shane J. LaRue
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  9. Scott Silvestry
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  10. Akinobu Itoh
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Corresponding author

Correspondence to Akinobu Itoh.

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Conflicts of interest

AT none, MEN none, AA none, JAE none, EN none, JMV none, GAE Thoratec (consultant); HeartWare (consultant), SJR none, SCS Thoratec (consultant); HeartWare (consultant), AI Thoratec (consultant).

Funding sources

This study was supported in part by research funds from the National Institutes of Health (NIH grant U10 HL110309, Heart Failure Network). No relationships with industry.

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Tibrewala, A., Nassif, M.E., Andruska, A. et al. Use of adenosine diphosphate receptor inhibitor prior to left ventricular assist device implantation is not associated with increased bleeding. J Artif Organs 20, 42–49 (2017). https://doi.org/10.1007/s10047-016-0932-7

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  • DOI: https://doi.org/10.1007/s10047-016-0932-7

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