Safety of Anticoagulation Reversal in Patients Supported with Continuous-Flow Left Ventricular Assist Devices

The purpose of this study was to characterize the potential thromboembolic risk associated with the reversal of warfarin-based anticoagulation in patients with continuous-flow left ventricular assist devices (CF-LVADs). All patients implanted with a CF-LVAD between January 1, 2008, and August 1, 2012, at our institution were screened, and those who received anticoagulation reversal during an inpatient admission were enrolled. The primary outcome is the incidence of thrombotic events, including stroke, device thrombosis, or venous thromboembolism within 30 days of anticoagulation reversal. Of the 122 patients screened, 25 patients experienced 38 anticoagulation reversal events. All patients received vitamin K at a mean dose of 10 +/- 8 mg, while 60% of patients received fresh frozen plasma. Only two patients received prothombin complex concentration and three patients received activated factor VII. The rate of thromboembolism within 30 days of attempted reversal was 2.6% (1/38). This patient developed an ischemic stroke after reversal with a high dose of activated factor VII for an acute intracranial bleed. The mortality rate within 30 days of reversal was 20% (5/25), with three of these deaths associated with acute intracranial hemorrhage. Anticoagulation reversal may be safely attempted in selected patients under CF-LVAD support.