Comparing two anticoagulant treatment, Warfarin (Standard treatment) and Apixaban (A new treatment) in patients with a Mechanical Heart for bleeding and thrombosis complications.

This study is comparing two blood-thinning medications in patients who have a ventricular assist device (VAD) implanted — a mechanical pump used to help a failing heart circulate blood, often as a bridge to heart transplant. Warfarin has been the standard anticoagulant for VAD patients for decades, but it requires frequent blood tests and dose adjustments. Apixaban (Eliquis) is a newer anticoagulant that does not require regular monitoring and is more predictable. Researchers want to know if apixaban 2.5 mg twice daily is as safe as warfarin at preventing blood clots and dangerous bleeds in this setting. Participants at St. Vincent's Hospital Sydney who are at least 2 months post-VAD implant with no recent bleeding or clotting events will be randomly assigned to either apixaban or warfarin. Both groups will also take aspirin 100 mg daily. Outcomes including bleeding, stroke, pump thrombosis, and survival will be closely tracked. To be eligible, you must be aged 18 to 70, have a left-sided VAD, weigh more than 60 kg, have adequate kidney function, and have had stable anticoagulation control (good INR time in range) in the preceding month. Patients with a recent stroke, major bleed, HIV, or on certain interacting medications are not eligible.