Omission of Antiplatelet Therapy in Patients With HeartMate 3 Left Ventricular Assist Devices: A Systematic Review and Meta-Analysis.

IF 3.1 3区 医学 Q2 ENGINEERING, BIOMEDICAL
ASAIO Journal Pub Date : 2024-11-01 Epub Date: 2024-05-10 DOI:10.1097/MAT.0000000000002225
Maximilian Tscharre, David Mutschlechner, Thomas Schlöglhofer, Dominik Wiedemann, Daniel Zimpfer, Thomas Gremmel
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引用次数: 0

Abstract

The HeartMate 3 (HM3) left ventricular assist device has decreased thromboembolic events and minimized the risk of pump thrombosis. However, bleeding complications due to combined antithrombotic therapy with a vitamin K antagonist (VKA) and aspirin remain high. Only limited data on the safety of VKA monotherapy in HM3 patients are available. A systematic search on the main databases was performed. Observational data and randomized trials were eligible for this analysis. As primary endpoint, we analyzed hemocompatibility-related adverse events (HRAE). As secondary endpoints, we investigated the individual components of the primary endpoint. The analysis was carried out using the odds ratio (OR) as outcome measure. A random-effects model was fitted to the data. Five manuscripts fulfilled the inclusion criteria. These trials included 785 patients (381 on VKA monotherapy, 404 on VKA and aspirin). VKA monotherapy significantly reduced HRAE (OR: 0.11 [95% confidence interval {CI}: 0.02-0.59], p = 0.01, I2 = 87%). The reduction was driven by a decrease in bleeding complications (OR: 0.12 [95% CI: 0.02-0.62], p = 0.01, I2 = 86%) without increasing the rates of thromboembolic events (OR: 0.69 [95% CI: 0.26-1.81], p = 0.45, I = 0%). Vitamin K antagonist monotherapy is associated with a significant reduction of bleeding events without increasing the risk of thromboembolic complications in HM3 patients.

使用 HeartMate 3 左心室辅助装置的患者放弃抗血小板治疗:系统综述与元分析》。
HeartMate 3(HM3)左心室辅助装置减少了血栓栓塞事件,最大限度地降低了泵血栓形成的风险。然而,使用维生素 K 拮抗剂 (VKA) 和阿司匹林联合抗血栓治疗引起的出血并发症仍然很高。目前有关 HM3 患者接受 VKA 单药治疗安全性的数据非常有限。我们在主要数据库中进行了系统性检索。观察性数据和随机试验均符合分析条件。作为主要终点,我们分析了血液相容性相关不良事件(HRAE)。作为次要终点,我们研究了主要终点的各个组成部分。分析采用几率比(OR)作为结果测量指标。数据采用随机效应模型。五篇手稿符合纳入标准。这些试验共纳入了 785 例患者(381 例接受 VKA 单药治疗,404 例接受 VKA 和阿司匹林治疗)。VKA 单一疗法可显著降低 HRAE(OR:0.11 [95% 置信区间 {CI}:0.02-0.59],p = 0.01,I2 = 87%)。降低的原因是出血并发症的减少(OR:0.12 [95% CI:0.02-0.62],p = 0.01,I2 = 86%),而血栓栓塞事件的发生率并未增加(OR:0.69 [95% CI:0.26-1.81],p = 0.45,I = 0%)。维生素 K 拮抗剂单药治疗可显著减少 HM3 患者的出血事件,而不会增加血栓栓塞并发症的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
ASAIO Journal
ASAIO Journal 医学-工程:生物医学
CiteScore
6.60
自引率
7.10%
发文量
651
审稿时长
4-8 weeks
期刊介绍: ASAIO Journal is in the forefront of artificial organ research and development. On the cutting edge of innovative technology, it features peer-reviewed articles of the highest quality that describe research, development, the most recent advances in the design of artificial organ devices and findings from initial testing. Bimonthly, the ASAIO Journal features state-of-the-art investigations, laboratory and clinical trials, and discussions and opinions from experts around the world. The official publication of the American Society for Artificial Internal Organs.
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