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This review provides evidence for pharmacological strategies to mitigate major LVAD-related complications in T2DM, in which endothelial dysfunction (via  impaired PI3K\/Akt-NO signaling), chronic inflammation, and diabetic nephropathy amplify the risk of thrombosis, bleeding, infection, and right ventricular (RV) failure. For thromboembolism prevention, individualized warfarin management (international normalized ratio: 2.0-3.0) with intensified monitoring is essential, while aspirin omission in magnetically levitated devices (2 trials) reduces bleeding. Phosphodiesterase-5 inhibitors show promise for thrombosis reduction, but require bleeding risk assessment. Glycemic control necessitates the proactive de-escalation of insulin\/sulfonylureas post-LVAD owing to improved insulin sensitivity and hypoglycemia risks, favoring SGLT-2 inhibitors\/GLP-1 receptor agonists for cardiometabolic benefits. Driveline infection management requires renal-adjusted antimicrobial prophylaxis, culture-directed therapy, and novel approaches for drug-resistant cases. The prevention of RV failure depends on preoperative hemodynamic optimization and post-operative inotropic support. A multidisciplinary approach integrating anticoagulation precision, infection control, glycemic tailoring, and hemodynamic stabilization is critical to counter T2DM-pathophysiology interactions.<\/jats:p>","DOI":"10.4239\/wjd.v16.i11.113005","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T02:10:51Z","timestamp":1763086251000},"source":"Crossref","is-referenced-by-count":1,"title":["Pharmacological management of major complications following left ventricular assist device implantation in type 2 diabetes 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