Postoperative early anticoagulation is mandatory to prevent thrombotic events. Intravenous administration is the primary choice: unfractionated heparin is commonly used, but successful use of direct thrombin inhibitors has been reported. Anticoagulation can be commenced 8 h after surgery with all devices if bleeding is <50 ml/h [338]. Initially, the target activated partial thromboplastin time is 40 s; it is progressively increased to 55–60 s within the first 48–72 h postoperatively. Oral anticoagulation with the vitamin K antagonist should be initiated once the clinical condition is considered stable and oral intake is possible. The international normalized ratio (INR) target is set according to device recommendations for modern LT-MCS devices. The INR target is between 2.0 and 3.0. Acetylsalicylic acid is routinely administered according to device specifications. The use of new oral anticoagulants is currently not recommended.