Can Preoperative Vitamin K Reduce Blood Transfusions After Left Ventricular Assist Device Implant?

The innovative study by Bansal and colleagues1Bansal A. Chan J. Bansal A. et al.Preoperative vitamin K reduces blood transfusions at time of left ventricular assist device implant.Ann Thorac Surg. 2020; 109: 787-793Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar in The Annals of Thoracic Surgery reports findings from a retrospective analysis demonstrating that preoperative vitamin K administration may help reduce blood product use without any increased risk for strokes or pump thrombosis in patients undergoing left ventricular assist device (LVAD) implantation. We have some comments. Coagulation and anticoagulation during perioperative LVAD implantation are complicated and hot topics of long standing. An array of key factors contributes to the initiation and progression of postoperative bleeding in LVAD implantation. Therefore, we do appreciate that Bansal and colleagues1Bansal A. Chan J. Bansal A. et al.Preoperative vitamin K reduces blood transfusions at time of left ventricular assist device implant.Ann Thorac Surg. 2020; 109: 787-793Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar controlled for some instrumental confounding factors: age, sex, race, body mass index, Interagency Registry for Mechanically Assisted Circulatory Support profile, total bilirubin concentration, surgeon, and year of surgery. However, it seems that they may have missed some critical perioperative factors. Emerging evidence indicates that preimplantation mechanical ventilation, dialysis, extracorporeal membrane oxygenation support, thrombocytopenia, and lower preoperative hematocrit are crucial risk factors for bleeding after LVAD implantation.2Miller RJH, Gregory AJ, Kent W, Banerjee D, Hiesinger W, Clarke B. Predicting transfusions during left ventricular assist device implant [e-pub ahead of print]. Semin Thorac Cardiovasc Surg. doi: 10.1053/j.semtcvs.2019.05.015, accessed November 19, 2008.Google Scholar, 3Muslem R. Caliskan K. van Thiel R. et al.Incidence, predictors and clinical outcome of early bleeding events in patients undergoing a left ventricular assist device implant.Eur J Cardiothorac Surg. 2018; 54: 176-182Crossref PubMed Scopus (16) Google Scholar, 4Boyle A.J. Jorde U.P. Sun B. et al.Pre-operative risk factors of bleeding and stroke during left ventricular assist device support: an analysis of more than 900 HeartMate II outpatients.J Am Coll Cardiol. 2014; 63: 880-888Crossref PubMed Scopus (172) Google Scholar In addition, the secondary outcomes of this study were stroke, pump thrombosis, and in-hospital mortality. To the best of our knowledge, clinical equipoise also exists regarding the most appropriate antithrombotic therapy in LVAD recipientss.5Rossi M. Serraino G.F. Jiritano F. Renzulli A. What is the optimal anticoagulation in patients with a left ventricular assist device?.Interact Cardiovasc Thorac Surg. 2012; 15: 733-740Crossref PubMed Scopus (73) Google Scholar However, Bansal and colleagues1Bansal A. Chan J. Bansal A. et al.Preoperative vitamin K reduces blood transfusions at time of left ventricular assist device implant.Ann Thorac Surg. 2020; 109: 787-793Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar did not distinguish among postoperative antithrombotic regimens in their study. In conclusion, we argue that not taking certain essential perioperative risk factors into account could have distorted the inferences of multivariate regression analyses and the ensuing comparisons made in this study. Preoperative Vitamin K Reduces Blood Transfusions at Time of Left Ventricular Assist Device ImplantThe Annals of Thoracic SurgeryVol. 109Issue 3PreviewCongestive heart failure patients have hepatic congestion and abnormal coagulation profiles, increasing perioperative bleeding at time of ventricular assist device implantation. This study examined the impact of the preoperative administration of vitamin K on perioperative blood transfusion requirements. Full-Text PDF Preoperative Use of Vitamin K Reduces Blood Transfusions at Time of LVAD Implants: ReplyThe Annals of Thoracic SurgeryVol. 109Issue 5PreviewWe thank Dr Feng and colleagues1 for their interest and appreciate their comments on our work.2 We agree with their views on the complexity of determining which perioperative risk factors are associated with perioperative bleeding in patients undergoing the implantation of left ventricular assist devices (LVADs). Full-Text PDF