To the editor,
We would like to thank Dr. Imamura [1] for his comments on our manuscript titled “The impact of peripheral arterial disease on patients with Circulatory mechanical support” [2]. The questions raised by Dr. Imamura are very valid. We agree with him that patients with peripheral arterial disease often receive dual antiplatelet therapy, including aspirin and P2Y12 inhibitors, to improve PAD symptoms and vessel patency post-intervention. It's a privilege to see our manuscript of interest to the readers. We also agree that patient post-LVAD receive antithrombotic medications, specifically warfarin, to prevent clotting with high INR targets (ranging from 2.5 to 3) and that patients with the peripheral arterial disease who are referred for left ventricular assist devices have multiple comorbidities, which put them at a higher risk for the adverse outcome for any surgery, especially cardiac surgery.
The question raised by Dr. Imamura concerning the antithrombotic and antiplatelet. Unfortunately, giving the nature of the database that we used, it is not possible to evaluate antiplatelet therapy or antithrombotic therapy that this patient received with and without PAD. The utilization of LVAD in patients with PAD has increased in recent years. Our data showed higher mortality in patients with PAD compared with no PAD. As we have summarized in our conclusion, the main message from this data analysis is that patients referred for left ventricular assist devices surgery should be appropriately screened for peripheral arterial disease and treated if possible before surgery. We don't know if intervention on PAD patients before LVAD surgery would alter the outcome of these patients since this question is out of the scope of our manuscript objective. Nevertheless, proper screening for claudication and tissue loss evaluation and ankle-brachial index testing is an essential step during workup for patients with advanced severe live ventricular dysfunction who require left ventricular assist device as a bridge or target therapy.
We would like to thank Dr. Imamura for his valuable comments and the Journal for giving us the opportunity to respond.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.ijcha.2020.100565.
Appendix A. Supplementary material
The following are the Supplementary data to this article:
References
- 1.Imamura T. Detailed association between peripheral arterial disease and comorbidity following left ventricular assist device implantation. IJC Heart Vasculat. 2020;28:100528. doi: 10.1016/j.ijcha.2020.100528. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ullah W., Sattar Y., Darmoch F. The impact of peripheral arterial disease on patients with mechanical circulatory support. IJC Heart Vasculat. 2020;28:100509. doi: 10.1016/j.ijcha.2020.100509. [DOI] [PMC free article] [PubMed] [Google Scholar]
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