Apixaban as Therapeutic Anticoagulation in Patients Supported by a Fully Magnetically Levitated Left Ventricular Assist Device.

Abstract

The HeartMate 3 (HM3) LVAD is an established therapy for advanced heart failure (HF) patients. Warfarin has been the recommended anticoagulant for patients supported by the HM3 LVAD; however, it is accompanied by complications secondary to the lack of time in therapeutic range, dosage related issues, and medical burden. In this study, we present our experience with apixaban as an alternative primary and chronic anticoagulant for patients supported with the HM3 LVAD. We performed a single center retrospective review of patients who were supported with the HeartMate 3 LVAD from January 2018 to October 2025 who were treated with apixaban as the primary and chronic anticoagulant. The INTERMACS database was used to evaluate patient clinical data and adverse events. Patients were assessed for survival and adverse events including bleeding, stroke, pump thrombosis, and hemolysis. 113 patients supported with the HM3 LVAD were treated with apixaban as the primary and chronic anticoagulant. Patients had a mean age of 57 and were predominantly male (70%), white (71%), 41% were diagnosed with ischemic cardiomyopathy, 25% with idiopathic cardiomyopathy, and 21% with other cardiomyopathies. By INTERMACS profile patients were classified as: 12% profile 1, 35% 2, 43% 3, 10% 4. There was a total of 272.8 patient years on apixaban with a mean of 2.4 years. There were 23 patients (20%) that experienced a bleeding event. There were 0.158 bleeding events per patient year (EPPY) with only 0.062 severe bleeding EPPY. 12 patients suffered 12 strokes (10%) with 0.022 ischemic stroke EPPY. There was no pump thrombosis or hemolysis events. Survival at 1 year and 5 years was 86% and 51%, respectively. Apixaban is a safe and effective primary and chronic therapeutic anticoagulant for patients on a HM3 LVAD.