Safety and Efficacy of Direct Oral Anticoagulants Versus Warfarin in Adults With Durable Left Ventricular Assist Devices: A Multicenter Retrospective Cohort Study.

Document Type

Article

Publication Date

3-2-2026

Publication Title

American journal of therapeutics

Abstract

BACKGROUND: The safety and efficacy of direct oral anticoagulants (DOACs) in patients with left ventricular assist devices (LVADs) remain uncertain because of limited comparative data with warfarin.

STUDY QUESTION: Are DOACs a safe and effective alternative to warfarin in patients with durable LVADs?

STUDY DESIGN: A retrospective cohort study using the TriNetX database was conducted. Adults with LVADs prescribed DOACs or warfarin were included. Propensity score matching (1:1) was performed to balance baseline characteristics.

MEASURES AND OUTCOMES: The primary outcome was all-cause mortality. Secondary outcomes included thromboembolic events, major bleeding, and blood transfusion requirements.

RESULTS: Among 3726 patients with LVAD, 79 received DOACs and 3647 received warfarin. After matching, 77 patients remained in each group. At 5 years, all-cause mortality was significantly lower in the DOAC group compared to warfarin (13% vs. 30%, P < 0.001). Rates of thromboembolism and major bleeding were similar, while blood transfusion needs were lower in the DOAC group (13% vs. 22.1%).

CONCLUSIONS: In this multicenter cohort, DOACs were associated with improved long-term survival and comparable safety outcomes relative to warfarin in LVAD patients. These findings suggest DOACs may be a viable alternative, but larger prospective studies are warranted.

DOI

10.1097/MJT.0000000000002033

ISSN

1536-3686

PubMed ID

41766068

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