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

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.