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Title: | Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock JACC Review Topic of the Week | Authors: | Vandenbriele, Christophe Arachchillage, Deepa J. Frederiks, Pascal Giustino, Gennaro Gorog, Diana A. Gramegna, Mario Janssens , Stefan Meyns , Bart Polzin, Amin Scandroglio, Mara Schrage, Benedikt Stone, Gregg W. Tavazzi, Guido Vanassche, Thomas VRANCKX, Pascal Westermann, Dirk Price, Susanna Chieffo, Alaide |
Issue Date: | 2022 | Publisher: | ELSEVIER SCIENCE INC | Source: | Journal of the American College of Cardiology (Print), 79 (19) , p. 1949 -1962 | 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. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. | Notes: | Vandenbriele, C (corresponding author), Univ Hosp Leuven, Dept Cardiovasc Dis, Herestr 49, B-3000 Leuven, Belgium. Christophe.vandenbriele@gmail.com |
Keywords: | anticoagulation management;bleeding;thrombosis | Document URI: | http://hdl.handle.net/1942/38016 | ISSN: | 0735-1097 | e-ISSN: | 1558-3597 | DOI: | 10.1016/j.jacc.2022.02.052 | ISI #: | 000831010300010 | Rights: | 2022 THE AUTHORS. PUBLISHED BY ELSEVIER ON BEHALF OF THE AMERICAN COLLEGE OF CARDIOLOGY FO UNDATION. THIS IS AN OPEN ACCESS ARTICLE UNDER THE CC BY-NC-ND LICENSE ( http://creativecommons.o rg/licenses/by-nc-nd/4.0/ ) . | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2023 |
Appears in Collections: | Research publications |
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Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock.pdf | Published version | 2.6 MB | Adobe PDF | View/Open |
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