Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock JACC Review Topic of the Week

Christophe Vandenbriele, Deepa J. Arachchillage, Pascal Frederiks, Gennaro Giustino, Diana A. Gorog, Mario Gramegna, Stefan Janssens, Bart Meyns, Amin Polzin, Mara Scandroglio, Benedikt Schrage, Gregg W. Stone, Guido Tavazzi, Thomas Vanassche, Pascal Vranckx, Dirk Westermann, Susanna Price, Alaide Chieffo

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Abstract

Interest in the use of mechanical circulatory support for patients presenting with cardiogenic shock is growing rapidly. The Impella (Abiomed Inc), a microaxial, continuous-flow, short-term, ventricular assist device (VAD), requires meticulous postimplantation management. Because systemic anticoagulation is needed to prevent pump thrombosis, patients are exposed to increased bleeding risk, further aggravated by sepsis, thrombocytopenia, and high shear stress–induced acquired von Willebrand syndrome. The precarious balance between bleeding and thrombosis in percutaneous VAD–supported cardiogenic shock patients is often the main reason that patient outcomes are jeopardized, and there is a lack of data addressing optimal anticoagulation management strategies during percutaneous VAD support. Here, we present a parallel anti-Factor Xa/activated partial thromboplastin time-guided anticoagulation algorithm and discuss pitfalls of heparin monitoring in critically ill patients. This review will guide physicians toward a more standardized (anti)coagulation approach to tackle device-related morbidity and mortality in this critically ill patient group.
Original languageEnglish
Pages (from-to)1949-1962
Number of pages14
JournalJournal of the American College of Cardiology
Volume79
Issue number19
Early online date9 May 2022
DOIs
Publication statusPublished - 17 May 2022

Keywords

  • anticoagulation management
  • bleeding
  • thrombosis

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