The use of direct oral anticoagulants in patients with ventricular assist devices: Is there hope for Factor Xa inhibition?

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Abstract
The use of continuous flow ventricular assist devices (cf‐VAD) necessitates systemic anticoagulation, routinely with vitamin K antagonism (VKA). Newer direct oral anticoagulants (DOACs) have significant advantages over VKA providing a predictable level of systemic anticoagulation without frequent monitoring or strict dietary surveillance. Despite randomised evidence to demonstrating their usefulness in several conditions including atrial fibrillation, there is limited data pertaining to their use in cf‐VAD patients. Early reports of adverse outcomes has resulted in a Class III recommendation, advising against DOACs generally in cf‐VAD patients1. Recent reports suggest there may be a role for certain DOACs; as such we present a systematic review identifying studies reporting DOAC uses in patients with a cf‐VAD. We identified eight pertinent studies, including a single randomised controlled trial and seven case reports/series. Limited numbers and significant study heterogeneity limits interpretation, however Factor Xa inhibitors appear to be feasible alternatives, favourable to direct thrombin inhibitors, although further research is required.

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