Recommendations for the use of anticoagulation during LT-MCS
Recommendations   Class   Level   References
Management of anticoagulation preoperative, perioperative and postoperative of LT-MCS implantation
If intraoperative extracorporeal life support or off-pump implantation is performed, administration of a reduced dose of heparin may be considered.  IIb  C
Early postoperative anticoagulation starting with intravenous anticoagulation, followed by vitamin K antagonists, is recommended.  I  C
The use of low-molecular-weight heparin as an early postoperative anticoagulation regimen should be considered.  IIa  C  [341]
A postoperative international normalized ratio target between 2.0 and 3.0 is recommended.  I  C
The use of acetylsalicylic acid is recommended.  I  C
The use of low-molecular-weight heparin for bridging during long-term support is recommended.  I  C
Re-evaluation of antithrombotic therapy during bleeding episodes is recommended.  I  C
The use of novel oral anticoagulants is not recommended.  III  B  [342]
Management of anticoagulation in the event of bleeding episodes
For a major bleeding event, discontinuation of anticoagulation and reversal with blood components and coagulation factors are recommended.  I  C  [343]
For minor bleeding, if the INR is above the therapeutic range, adjustment of anticoagulation agents should be considered.  IIa  C
In all cases of bleeding, exploration and treatment of a bleeding site should be considered.  IIa  C  [344]
After resolution of the first bleeding episode, discontinuation of long-term acetylsalicylic acid should be considered.  IIa  C
INR: international normalized ratio; LT-MCS: long-term mechanical circulatory support.