The Safety of Dropping Aspirin in HeartMate 3 LVAD Patients: A Critical Analysis

The ARIES-HM3 trial has provided new insights into the antithrombotic regimen for patients with HeartMate 3 left ventricular assist devices (LVADs). The trial compared the outcome of dropping aspirin from the treatment regimen after LVAD implantation, and the results suggest that this approach may be safer than the conventional combination therapy. This article critically examines the trial findings, analyzes their implications, and discusses the potential impact on clinical practice.

The ARIES-HM3 trial randomized 628 patients with advanced heart failure who received a HeartMate 3 LVAD to either aspirin or placebo in addition to their existing vitamin K antagonist therapy. The primary composite endpoint of survival free of stroke, pump thrombosis, major nonsurgical bleeding, and arterial peripheral thromboembolism over 24 months was analyzed. The trial demonstrated that placebo was noninferior to low-dose aspirin (68% vs. 74%, P


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