LAUSR

Introduction: LVAD management is really challenging since inadequate anticoagulation treatment can lead to life threatening sistuations like ischemic stroke or pump thrombosis. Main intention of our study was to investigate if early identification of aspirin non responders can improve anticoagulation management and then reduce the risk of pump thrombosis. Methods: From december 2010 to may 2018 24 patients were implanted with HM II, 6 received an HVAD and 22 an HM 3. A target INR of 2.0 to 3.0 was maintained in all the patients. 100 mg aspirin were initiated only when a normal platelet function emerged at basal postoperative aggregometry. Aspirin non responders were early identified by repeating the aggregometry after seven days of administration and then clopidogrel 75 mg was used and platelet function tested again. Ticlopidine 250 mg was administrated when also clopidogrel was unsuccessful. Results: 6 patients required modification in antiplatelet therapy. 3 patients (5%), 2 HVAD and 1 HM II, suffered from pump thromosis. 1 patient died as a consequence of large intracranial hemorragic event following thrombolitic treatment. 1 patient required pump exchange and in 1 patient thrombolitic infusion was conducted successfully. Conclusions: reported rates of pump thrombosis at 12 months for patients implanted with commonly used LVADs are 6 % to 12 % for axial - flow pumps and 8 % with centrifugal - flow devices. in our serie the reported 5 % overall incidence of pump thrombosis encourage the routine use of aggregometry test to early identify aspirin non responders.