Anti-thrombotic Monotherapy With the HeartMate 3 LVAS

Inclusion Criteria: * patients implanted with HeartMate 3 LVAS irrespective of intended goal of treatment of bridge to transplant or destination therapy * 6 months or more on reduced anti-coagulation regimen (target INR 1.5-1.9) free of thromboembolic and thrombotic complications * evidence of forward flow across the aortic valve (with aortic valve opening of at least 1:2 per cardiac cycle) at baseline echocardiography (ECHO) or after the speed optimization without a significant progression of heart failure based on a biomarker and complex clinical assessment follow-up Exclusion Criteria: * absence of an informed consent * presence of any prosthetic valve * known history of major thrombotic event e.g. DVT * known history of stroke * left atrial appendage in patients with atrial fibrillation or flutter not addressed by resection or exclusion at a time of the implant * evidence of any intracardiac thrombus * any clinical indication for use of long-term warfarin anticoagulation (e.g. known genetic thrombotic mutation, malignancy)