Which thromboprophylactic strategy is recommended for a patient post-HeartMate III implantation?

The recommended thromboprophylactic strategy post-HeartMate III implantation involves the use of lower-dose aspirin along with warfarin, aiming for a target INR of 2.0 to 3.0. The reasoning for using aspirin at a dose of 81 mg/day is based on its efficacy in reducing the risk of thromboembolic events while minimizing the risk of bleeding, which is particularly significant in patients who have undergone mechanical support placement.

The choice of a target INR range of 2.0 to 3.0 is established to provide adequate anticoagulation in this patient population. Lowering the INR target to 2.0 may help reduce bleeding complications that are associated with higher INR values, especially in a vulnerable population like patients with mechanical circulatory support.

By combining these two agents—low-dose aspirin for antiplatelet effects and warfarin for its anticoagulant properties—a balanced approach is achieved to mitigate the risks of thrombosis and bleeding, which is crucial after HeartMate III implantation. This strategy is consistent with clinical guidelines and expert recommendations for managing anticoagulation in patients with left ventricular assist devices (LVADs).