{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T09:42:14Z","timestamp":1787391734311,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:00:00Z","timestamp":1732060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>HeartMate 3 (HM3), a fully magnetically levitated ventricular assist device (LVAD), has been associated with reduced thromboembolic events compared to HeartMate II. However, bleeding events remained significant. Among patients undergoing HM3 implantation, the standard antithrombotic regimen comprises both warfarin and aspirin (ASA), but there is a lack of evidence on the optimum antithrombotic therapy. We performed a systematic review and meta\u2010analysis assessing the impact of combined ASA and warfarin therapy compared to warfarin alone on the incidence of non\u2010surgical bleeding events in patients with HM3 LVAD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and observational studies comparing warfarin alone with warfarin combined with ASA in patients with HM3 LVAD. Binary endpoints were analyzed using computed risk ratios (RRs) with 95% confidence intervals (CIs). A random\u2010effect model was applied for all endpoints.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five studies (one RCT and four observational) encompassing 869 patients were included, with 424 (48.8%) prescribed warfarin alone, and 662 (76.2%) being male. Compared with the combined anticoagulation regimen, warfarin alone significantly reduced non\u2010surgical bleeding (RR 0.30; 95% CI 0.09\u20130.95; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.04) and gastrointestinal bleeding (RR 0.26; 95% CI 0.12\u20130.58; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). There was no statistically significant difference between the groups for all\u2010cause mortality (RR 1.02; 95% CI 0.45\u20132.32; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.963).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings indicate that the use of warfarin alone for anticoagulation in HM3 patients is associated with a reduced risk of bleeding events when compared to the combined therapy with ASA.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.15110","type":"journal-article","created":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T16:55:23Z","timestamp":1732121723000},"page":"53-58","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Warfarin and Aspirin Versus Warfarin Alone in Patients With HeartMate 3 Left Ventricular Assist Device: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8139-3963","authenticated-orcid":false,"given":"Patricia","family":"Viana","sequence":"first","affiliation":[{"name":"Department of Medicine University of the Extreme South of Santa Catarina Criciuma Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucca Moreira","family":"Lopes","sequence":"additional","affiliation":[{"name":"Department of Medicine Sciences Medical School of Santos Santos Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thamiris Dias Delfino","family":"Cabral","sequence":"additional","affiliation":[{"name":"Department of Medicine Souza Marques Medical School Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Persson","sequence":"additional","affiliation":[{"name":"Department of Medicine University of the Extreme South of Santa Catarina Criciuma Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa de Oliveira","family":"Tapioca","sequence":"additional","affiliation":[{"name":"Department of Medicine Bahiana School of Medicine and Public Health Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila Veronica S.","family":"Freire","sequence":"additional","affiliation":[{"name":"Department of Medicine Bahiana School of Medicine and Public Health Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica Hoffmann","family":"Relvas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Mandaqui Hospital Complex S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Mesquita","sequence":"additional","affiliation":[{"name":"Department of Medicine Federal University of Rio de Janeiro Maca\u00e9 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabela Reis","family":"Marques","sequence":"additional","affiliation":[{"name":"Department of Medicine Universitat Internacional de Catalunya Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilton Francisco","family":"Gomes","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology INC Hospital Curitiba Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2023.05.013"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1284"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.12.021"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1468"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2020.06.012"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2019.05.006"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2017.05.008"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.23204"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2022.101506"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.14652"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14433"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2022.03.007"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.14432"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2021.11.016"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000000388"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.16197"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.028303"}],"container-title":["Pacing 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Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.15110","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T02:57:37Z","timestamp":1741748257000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.15110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,20]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/pace.15110"],"URL":"https:\/\/doi.org\/10.1111\/pace.15110","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,20]]},"assertion":[{"value":"2024-07-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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