Anticoagulation for Cardiac Prosthetic Devices: Prosthetic Heart Valves, Left Ventricular Assist Devices, and Septal Closure Devices

From the development of open heart surgery in the 1950s, dramatic technological advances have facilitated progressively complex cardiac procedures with approaches ranging from the open or minimally invasive surgical to the percutaneous endovascular. Treatments that involve securing prosthetic material in, or in communication with, the heart are employed in a variety of cardiac pathologies, including valvular heart disease, cardiomyopathy, and undesired communications between cardiac chambers. These devices carry with them the risk of thromboembolic complications that are mitigated by the use of antithrombotic therapies. In this chapter, we review the features of cardiac prosthetic devices associated with thrombosis, the indications for device use, their hematologic complications, and the evidence guiding current recommendations for management of these devices. Cardiac devices discussed include prosthetic heart valves (mechanical, bioprosthetic, and transcatheter aortic valves), valve repair (surgical, MitraClip, and endovascular plugs for prosthetic paravalvular leak), left ventricular assist devices (LVADs), temporary mechanical circulatory support, septal closure devices, and left atrial appendage (LAA) occlusion devices.