Trial of Low-intensity Anticoagulation to Reduce GI or Other Bleeding Complications With Equivalent Therapeutic Efficacy in HeartMate 3 LVAD Patients

Exclusion Criteria

• •Patients who meet any of the following criteria will be excluded:
• •Patients implanted with any mechanical assist device other than HeartMate 3 LVAD (e.g., other LVAD models, RVAD, BiVAD).
• •Patients with a clinically significant stroke or transient ischemic attack (TIA) within the past 6 months.
• •Patients with a history of hemorrhagic stroke.
• •Patients who experienced major bleeding events within the past 6 months (based on INTERMACS major bleeding criteria).
• •Patients with uncontrolled severe hypertension (systolic ≥180 mmHg or diastolic ≥110 mmHg).
• •Patients requiring active treatment or surgical intervention for acute LVAD-related thrombosis or hemodynamic instability, or patients who underwent LVAD-related reoperation within the past 30 days.
• •Patients with severe renal dysfunction (estimated Glomerular Filtration Rate \<15 mL/min) or patients undergoing dialysis.
• •Patients with severe liver dysfunction causing coagulation abnormalities or those classified as Child-Pugh class B or C.
• •Patients with active bleeding or ongoing hemorrhagic conditions.
• •Patients with a high bleeding risk due to:
• •Gastrointestinal bleeding or ulcers within the past 6 months.
• •Surgery involving the brain, spine, or eyes within the past 6 months.
• •Major central nervous system, ophthalmologic, or major open surgical procedures within the past 6 months.
• •Presence or suspicion of esophageal varices.
• •Arteriovenous malformation or vascular aneurysm.
• •Patients who have received thrombolytic therapy for bleeding or thromboembolism within the past 30 days.
• •Patients receiving long-term concurrent treatment with other anticoagulants (low molecular weight heparin, NOAC, Fondaparinux, etc.). However, temporary administration for warfarin bridging or heparin use for central venous or arterial catheter maintenance is permitted.
• •Patients with persistent anemia (hemoglobin \<8 g/dL) or thrombocytopenia (platelet count \<50,000/µL) within the past 6 months.
• •Patients currently experiencing infective endocarditis.
• •Patients with a history of severe allergy or hypersensitivity to warfarin or other anticoagulants used in this study.
• •Pregnant or lactating women, or women planning pregnancy during the study period.
• •Patients with severe terminal illness with a life expectancy of less than 12 months.
• •Patients with alcohol dependence or severe psychiatric conditions hindering study participation.
• •Patients unwilling or unable to adhere to the procedures or evaluations required by the study protocol.
• •Patients currently participating in another randomized drug or medical device clinical trial who have not yet completed the primary endpoint assessment.