Factor Concentrates for the Treatment of Acquired Coagulopathy in Patients With Left Ventricular Assist Devices: A Systematic Review.

Patients with left ventricular assist devices (LVADs) represent a high-risk population at risk of both bleeding and thrombotic complications. A review of the available literature on nonfibrinogen factor concentrate use in LVAD patients up to June 1, 2026, was conducted by searching MEDLINE, Embase, and clinical trial and review registries. A total of 2,355 studies were identified, and 14 retrospective studies were included. Seven studies used factors to treat bleeding during LVAD implant or exchange. In this context, 134 patients received prothrombin complex concentrate (PCC), 487 received usual management or frozen plasma, 82 received factor eight inhibitor bypassing activity (FEIBA), 78 received recombinant activated factor VII (rVIIa), and 5 received isolated factor IX complex/3F-PCC. Given the limited and heterogeneous evidence, this review provides a descriptive summary of eligible studies rather than a formal evidence synthesis. When used first-line and protocolized, PCC is likely safe and effective. rFVIIa appears effective, but higher doses are associated with thrombosis and mortality. Evidence for FEIBA is limited to one small nonrandomized study. Seven studies used factors for emergency anticoagulation reversal, with 139 individual PCC exposures, 47 frozen plasma exposures, and 3 rVIIa exposures. PCC was associated with more rapid International Normalized Ratio normalization, no excess harm, and, in one study, improved survival and progression to transplant. In this context, rFVIIa was associated with a dose-dependent risk of thrombosis. Overall, PCC-based hemostatic management in LVAD patients appears reasonable; however, it is not currently possible to judge the safety of low-dose rVIIa or FEIBA.