Direct Oral Anticoagulant Therapy with A Fully Magnetically Levitated LVAD and Bridging to Heart Transplantation: A DOT-HM3 Study Analysis

A therapeutic standard has been established with evidence of long-term survival with use of a fully magnetically levitated HeartMate 3 (HM3) LVAD (Abbott). 1 Mehra MR Goldstein DJ Cleveland JC Cowger JA Hall S Salerno CT Naka Y Horstmanshof D Chuang J Wang A Uriel N. Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial. JAMA. 2022; 328: 1233-1242 Crossref PubMed Scopus (157) Google Scholar Outcomes with this pump have shown low rates in hemocompatibility related adverse events (pump thrombosis, stroke and non-surgical bleeding) and it has been argued that thrombo-resistance demonstrated with this pump may facilitate consideration of direct oral anticoagulants (DOAC) that inhibit Factor Xa although studies in legacy LVADs such as the HeartWare HVAD (Medtronic) demonstrated an increase in thrombotic complications with use of dabigatran. 2 Andreas M Moayedifar R Wieselthaler G et al. Increased Thromboembolic Events With Dabigatran Compared With Vitamin K Antagonism in Left Ventricular Assist Device Patients: A Randomized Controlled Pilot Trial. Circ Heart Fail. 2017; 10e003709 Crossref PubMed Scopus (59) Google Scholar