{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T08:08:14Z","timestamp":1791878894330,"version":"4.3.4"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001316","name":"Abbott","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001316","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>ARIES-HM3 was an international, randomized, double-blind, placebo-controlled study of aspirin (100\u2005mg\/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\u2013Gill model with TTR as a single continuous variable, and multivariable regression analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u226556% (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\u20132.53) without stroke increase (3.2 vs 2.8 events per 100 participant-years; rate ratio 0.88 [95% CI: 0.30\u20132.53]). 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\u20132.57]; 1.62 [95% CI: 1.11\u20132.35], respectively), with more frequent INRs below the therapeutic range. Multivariable modelling identified age \u226565 years, aspirin use, TTR &amp;lt;56%, and blood urea nitrogen \u226530\u2005mg\/dL as predictors of non-surgical bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehaf745","type":"journal-article","created":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T09:40:57Z","timestamp":1762681257000},"page":"942-952","source":"Crossref","is-referenced-by-count":10,"title":["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"],"prefix":"10.1093","volume":"47","author":[{"given":"Jean M","family":"Connors","sequence":"first","affiliation":[{"name":"Center for Advanced Heart Disease, Brigham and Women\u2019s Hospital and Harvard Medical School , 75 Francis Street, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2144-341X","authenticated-orcid":false,"given":"Finn","family":"Gustafsson","sequence":"additional","affiliation":[{"name":"Rigshospitalet, University of Copenhagen , Blegdamsvej 9, 2100 Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2301-3587","authenticated-orcid":false,"given":"Nir","family":"Uriel","sequence":"additional","affiliation":[{"name":"Heart Failure, Heart Transplant & Mechanical Circulatory Support, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital , 622 W 168th St, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis D","family":"Pagani","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University of Michigan , 1500 East Medical Center Dr, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich P","family":"Jorde","sequence":"additional","affiliation":[{"name":"Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care , 111 East 210th Street, Bronx, NY 10467, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason N","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Medicine, NYU Grossman School of Medicine and Bellevue Hospital , 530 1st Ave, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1567-7036","authenticated-orcid":false,"given":"Ivan","family":"Netuka","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine , Videnska 1958\/9, Prague 4-140 21 ,","place":["Czech 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Cardiology, Duke University Medical Center , 40 Duke Medicine Circle Clinic, Durham, NC 27710, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirnela","family":"Byku","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill , 100 Eastowne Dr, Chapel Hill, NC 27514, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael M","family":"Givertz","sequence":"additional","affiliation":[{"name":"Center for Advanced Heart Disease, Brigham and Women\u2019s Hospital and Harvard Medical School , 75 Francis Street, Boston, MA 02115, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley","family":"Hall","sequence":"additional","affiliation":[{"name":"Baylor Scott & White Advanced Heart Failure, Baylor University Hospital , 3410 Worth St Ste 250, Dallas, TX 75246, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manreet K","family":"Kanwar","sequence":"additional","affiliation":[{"name":"Allegheny Health Network , Cardiovascular Institute, 320 E North Ave, Pittsburgh, PA 15212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Cogswell","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical Center Fairview , 909 Fulton Street Southeast, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9687-9475","authenticated-orcid":false,"given":"Farooq H","family":"Sheikh","sequence":"additional","affiliation":[{"name":"MedStar Heart and Vascular Institute, Georgetown University School of Medicine , 110 Irving St NW, Washington, DC 20010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Phancao","sequence":"additional","affiliation":[{"name":"Kardia 360 , 12620 Ramiro St, Coral Gables, FL 33156, 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