Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation
Background Left ventricular assist device (LVAD) thrombosis is clinically devastating and impacts the cost effectiveness of LVAD therapy for advanced heart failure. Anticoagulation and antiplatelet therapies represent the standard of care to mitigate LVAD thrombosis. Phosphodiesterase type 5 inhibit...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.015897 |
| _version_ | 1819175169180041216 |
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| author | Andrew Xanthopoulos Konstantinos Tryposkiadis Filippos Triposkiadis Kiyotaka Fukamachi Edward G. Soltesz James B. Young Kathy Wolski Eugene H. Blackstone Randall C. Starling |
| author_facet | Andrew Xanthopoulos Konstantinos Tryposkiadis Filippos Triposkiadis Kiyotaka Fukamachi Edward G. Soltesz James B. Young Kathy Wolski Eugene H. Blackstone Randall C. Starling |
| author_sort | Andrew Xanthopoulos |
| collection | DOAJ |
| description | Background Left ventricular assist device (LVAD) thrombosis is clinically devastating and impacts the cost effectiveness of LVAD therapy for advanced heart failure. Anticoagulation and antiplatelet therapies represent the standard of care to mitigate LVAD thrombosis. Phosphodiesterase type 5 inhibitors (PDE‐5is) exhibit hemodynamic, antiplatelet, and antithrombotic effects. Using a national registry, we examined the relationship of PDE‐5i use on thrombotic events in patients with continuous‐flow LVADs. Methods and Results We obtained data from 13 772 patients with continuous flow LVADs participating in a national registry. Patients implanted with primary LVADs from 2012 to 2017 were included in the analysis. The primary end point was a composite of LVAD thrombosis and ischemic stroke. Patients were analyzed according to any use of PDE‐5i after LVAD implantation (PDE‐5i group) versus no use after LVAD implantation (no PDE‐5i group). The primary end point was significantly lower in the PDE‐5i group compared with the no PDE‐5i group (hazard ratio [HR], 0.84; 95% CI, 0.77–0.91; P<0.001) at 48 months. The components of the primary end point (LVAD thrombosis: HR, 0.82; 95% CI, 0.74–0.90; P<0.001; and ischemic stroke: HR, 0.85; 95% CI, 0.75–0.97; P=0.019), as well as the secondary end point all‐cause mortality (HR, 0.86; 95% CI, 0.79–0.93; P<0.001) were lower in the PDE‐5i group versus the no PDE‐5i at 48 months post LVAD. The favorable results observed with postimplant PDE‐5i use were consistent with both axial and centrifugal flow devices. Conclusions The postimplant use of PDE‐5i was associated with fewer thrombotic events and improved survival in LVAD patients. A randomized clinical trial is warranted to confirm these findings. |
| first_indexed | 2024-12-22T20:50:35Z |
| format | Article |
| id | doaj.art-cd0e9c216a304f2784340e353f93088b |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T20:50:35Z |
| publishDate | 2020-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-cd0e9c216a304f2784340e353f93088b2022-12-21T18:13:06ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-07-0191410.1161/JAHA.119.015897Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device ImplantationAndrew Xanthopoulos0Konstantinos Tryposkiadis1Filippos Triposkiadis2Kiyotaka Fukamachi3Edward G. Soltesz4James B. Young5Kathy Wolski6Eugene H. Blackstone7Randall C. Starling8Kaufman Center for Heart Failure, Heart and Vascular Institute Cleveland Clinic Cleveland OHIndependent Biostatistician Athens GreeceDepartment of Cardiology University General Hospital of Larissa GreeceKaufman Center for Heart Failure, Heart and Vascular Institute Cleveland Clinic Cleveland OHKaufman Center for Heart Failure, Heart and Vascular Institute Cleveland Clinic Cleveland OHKaufman Center for Heart Failure, Heart and Vascular Institute Cleveland Clinic Cleveland OHKaufman Center for Heart Failure, Heart and Vascular Institute Cleveland Clinic Cleveland OHKaufman Center for Heart Failure, Heart and Vascular Institute Cleveland Clinic Cleveland OHKaufman Center for Heart Failure, Heart and Vascular Institute Cleveland Clinic Cleveland OHBackground Left ventricular assist device (LVAD) thrombosis is clinically devastating and impacts the cost effectiveness of LVAD therapy for advanced heart failure. Anticoagulation and antiplatelet therapies represent the standard of care to mitigate LVAD thrombosis. Phosphodiesterase type 5 inhibitors (PDE‐5is) exhibit hemodynamic, antiplatelet, and antithrombotic effects. Using a national registry, we examined the relationship of PDE‐5i use on thrombotic events in patients with continuous‐flow LVADs. Methods and Results We obtained data from 13 772 patients with continuous flow LVADs participating in a national registry. Patients implanted with primary LVADs from 2012 to 2017 were included in the analysis. The primary end point was a composite of LVAD thrombosis and ischemic stroke. Patients were analyzed according to any use of PDE‐5i after LVAD implantation (PDE‐5i group) versus no use after LVAD implantation (no PDE‐5i group). The primary end point was significantly lower in the PDE‐5i group compared with the no PDE‐5i group (hazard ratio [HR], 0.84; 95% CI, 0.77–0.91; P<0.001) at 48 months. The components of the primary end point (LVAD thrombosis: HR, 0.82; 95% CI, 0.74–0.90; P<0.001; and ischemic stroke: HR, 0.85; 95% CI, 0.75–0.97; P=0.019), as well as the secondary end point all‐cause mortality (HR, 0.86; 95% CI, 0.79–0.93; P<0.001) were lower in the PDE‐5i group versus the no PDE‐5i at 48 months post LVAD. The favorable results observed with postimplant PDE‐5i use were consistent with both axial and centrifugal flow devices. Conclusions The postimplant use of PDE‐5i was associated with fewer thrombotic events and improved survival in LVAD patients. A randomized clinical trial is warranted to confirm these findings.https://www.ahajournals.org/doi/10.1161/JAHA.119.015897complicationsheart failurepharmacologysildenafil |
| spellingShingle | Andrew Xanthopoulos Konstantinos Tryposkiadis Filippos Triposkiadis Kiyotaka Fukamachi Edward G. Soltesz James B. Young Kathy Wolski Eugene H. Blackstone Randall C. Starling Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease complications heart failure pharmacology sildenafil |
| title | Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation |
| title_full | Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation |
| title_fullStr | Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation |
| title_full_unstemmed | Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation |
| title_short | Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation |
| title_sort | postimplant phosphodiesterase type 5 inhibitors use is associated with lower rates of thrombotic events after left ventricular assist device implantation |
| topic | complications heart failure pharmacology sildenafil |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.015897 |
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