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

Mohammed Mhanna; Abdallah AbuJlambo; Omar Mousa; Krishna Sagar Gajula; Mubariz Hassan; Ahmad Al-Abdouh; Ahmad Jabri; Mahmoud Barbarawi; Shareef Mansour; Ernesto Ruiz Duque

doi:10.1097/MJT.0000000000002033

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

Journal article

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

Mohammed Mhanna, Abdallah AbuJlambo, Omar Mousa, Krishna Sagar Gajula, Mubariz Hassan, Ahmad Al-Abdouh, Ahmad Jabri, Mahmoud Barbarawi, Shareef Mansour and Ernesto Ruiz Duque

American journal of therapeutics

03/02/2026

DOI: 10.1097/MJT.0000000000002033

PMID: 41766068

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Abstract

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. Are DOACs a safe and effective alternative to warfarin in patients with durable LVADs? 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. The primary outcome was all-cause mortality. Secondary outcomes included thromboembolic events, major bleeding, and blood transfusion requirements. 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%). 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.

left ventricular assist devices

bleeding

thromboembolism

DOACs

anticoagulation

warfarin

Details

Title: Subtitle: Safety and Efficacy of Direct Oral Anticoagulants Versus Warfarin in Adults With Durable Left Ventricular Assist Devices: A Multicenter Retrospective Cohort Study
Creators: Mohammed Mhanna - University of Iowa
Abdallah AbuJlambo - Dar Al-Shifa Hospital
Omar Mousa - Ollscoil na Gaillimhe – University of Galway
Krishna Sagar Gajula - University of Iowa
Mubariz Hassan - University of Iowa
Ahmad Al-Abdouh - University of Kentucky
Ahmad Jabri - Beaumont Hospital, Royal Oak
Mahmoud Barbarawi - University of Connecticut
Shareef Mansour - The University of Texas Medical Branch at Galveston
Ernesto Ruiz Duque - University of Iowa
Resource Type: Journal article
Publication Details: American journal of therapeutics
DOI: 10.1097/MJT.0000000000002033
PMID: 41766068
NLM abbreviation: Am J Ther
ISSN: 1536-3686
eISSN: 1536-3686
Publisher: Lippincott
Language: English
Electronic publication date: 03/02/2026
Academic Unit: Internal Medicine
Record Identifier: 9985141999302771

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