{"id":"54eeef19d09e","type":"article","url":"https://hartvaat.nl/2026/02/23/aspirinestop-bij-lvad-met-vka-veiligheidsanalyse/","title":"Aspirinestop bij LVAD met VKA: veiligheidsanalyse","title_en":"Withdrawal of aspirin in patients with left ventricular assist device treated with vitamin K antagonists: impact of anticoagulation quality in the randomized ARIES-HM3 trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["aspirine"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehaf745","source_url":"https://doi.org/10.1093/eurheartj/ehaf745","authors":["Jean M Connors","Finn Gustafsson","Nir Uriel","Francis D Pagani","Ulrich P Jorde","Jason N Katz","Ivan Netuka","Daniel Zimpfer","Hassan Nemeh","John M Ransom","Richa Agarwal","Mirnela Byku","Michael M Givertz","Shelley Hall","Manreet K Kanwar","Rebecca Cogswell","Farooq H Sheikh","Anita Phancao","Ashwin Ravichandran","Jennifer Conway","Eric Adler","Eugene S Chung","Jonathan Grinstein","Nicholas Dirckx","Nourdine Chakouri","Mandeep R Mehra"],"significance":6,"published":"2026-02-23","source_date":"2026-02-23","image":"","kennis":[],"congress":"","summary_en":"This study showed that withdrawing aspirin in LVAD patients on vitamin K antagonists is safe with fewer bleeding events, supporting simplification of the antithrombotic regimen in mechanically supported patients.","created":"2026-07-03T10:32:12Z","updated":"2026-07-03T13:31:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie onderzocht de veiligheid van aspirinestop bij LVAD-patiënten op VKA. Het weglaten van aspirine was veilig met minder bloedingen, consistent met de trend naar minder agressieve antitrombotische regimes.","abstract_original":"BACKGROUND AND AIMS: Left ventricular assist devices (LVADs), including the HeartMate 3 (HM3), have improved outcomes in patients with advanced heart failure. Use of vitamin K antagonists (VKA) is mandated to reduce the risk of thrombotic events, but there is heterogeneity in management. Time in therapeutic range (TTR) is a crucial metric for assessing the quality of VKA management. The ARIES-HM3 trial demonstrated that aspirin can be safely omitted from the antithrombotic regimen, resulting in reduced bleeding without increased thrombosis. This pre-specified trial analysis explores the relationship of quality of VKA management assessed by TTR with haemocompatibility-related outcomes. METHODS: ARIES-HM3 was an international, randomized, double-blind, placebo-controlled study of aspirin (100 mg/day) or placebo (1:1) with VKA therapy in patients with de-novo HM3 placement. Participants were stratified into low TTR or high TTR groups based on median levels (n = 554). Primary endpoint success and secondary endpoint rates were stratified based on TTR groups. Bleeding rates at 12 months were estimated using an Andersen-Gill model with TTR as a single continuous variable, and multivariable regression analysis was performed. RESULTS: The percentage of patients with a TTR above or below the median of 56 was similar between the aspirin and placebo groups. More participants achieved primary endpoint success with TTR ≥56% (77% vs 66.9%, P = .01). Higher TTR was associated with lower bleeding rates at 12 months (26.4 vs 49.2 events per 100 participant-years; rate ratio 1.84, 95% confidence interval [CI] 1.37-2.53) without stroke increase (3.2 vs 2.8 events per 100 participant-years; rate ratio 0.88 [95% CI: 0.30-2.53]). No interaction was observed between the assigned treatment group and TTR. Modelling demonstrated a constant decrease in bleeding as a function of increasing TTR. Female sex and Black race were independent predictors of low TTR (odds ratio: 1.70 [95% CI: 1.12-2.57]; 1.62 [95% CI: 1.11-2.35], respectively), with more frequent INRs below the therapeutic range. Multivariable modelling identified age ≥65 years, aspirin use, TTR <56%, and blood urea nitrogen ≥30 mg/dL as predictors of non-surgical bleeding. CONCLUSIONS: The quality of VKA management as measured by TTR correlates with the occurrence of non-surgical bleeding in patients with the HM3 LVAD, with a lower TTR associated with an increased bleeding risk. These data provide new clinical direction to define a benchmark TTR to achieve further mitigation of residual risk of bleeding and enhance haemocompatibility with the HM3 LVAD."}