HEMORRHAGIC AND THROMBOEMBOLIC COMPLICATI ONS IN PATIENTS WITH IMPLANTED LEFT VENTRICULAR ASSIST DEVICES IN EARLY POSTOPERATIVE PERIOD
DOI:
https://doi.org/10.31379/2411.2616.13.1.1Keywords:
left ventricular assist device (LVAD), anticoagulant targeted therapy (ACTT), hemorrhagic and thromboembolic complications.Abstract
The work is devoted to study hemorrhagic and thromboembolic complications in early postoperative period after implantation of left ventricular assist devices (LVAD). We performed retrospective analysis of 10 patients, males aged 55±13.5 years, with a BMI of 30.8±8.3, with a left ventricular ejection fraction ranging from 9% to 28%, which in the period from 11.03.2016 to 22.11.2017 year, in the Silesian center of the Heart Disease (Poland), in conditions of artificial blood circulation, LVAD was implanted. In the early postoperative period, patients received daily anticoagulant target therapy (ACCT), consisting of the following drugs: heparin (6-11 U/kg/h), aspirin (75-150 mg), Clopidogrel (75-150 mg), warfarin (1.5-7 mg), Nadroparinum Ca (0.3-0.6 ml/twice on day), Fondaparinux Na (2.5-5 mg/twice on day). Two patients received mono-heparin therapy, one patient received monotherapy with warfarin for 14 days. Other patients during the same period received combined heparin therapy in the first three days with a subsequent transition to warfarin, aspirin, Clopidogrel, Fraxiparin, or thrombin blocker. The mechanical support of the left ventricle was carried out essentially by two different implantable systems, performing one function of support of the left ventricle: POLVAD – programmed controlled pneumatic membrane mechanical circulation of blood to two patients, and LVAD program-controlled electrocentrifugal circulation for eight patients. The duration of support by POLVAD system was from 102 to 156 days. Length of support – LVAD ranged from 20 to 78 days. A comparison of the analyzed results led to the conclusion that anticoagulant mono-therapy with heparin or warfarin leads to an increase in the percentage of complications and mortality compared with the alternative combination anticoagulant targeted therapy consisting of the following drugs: heparin (6- 11 U/kg/h), aspirin 75-150 mg), Clopidogrel (75-150 mg), warfarin (1.5-7 mg), Nadroparinum Ca (0.3-0.6 ml/ twice on day), Fondaparinux Na (2.5- 5 mg/ twice on day), Where survival rates were significantly higher by 60%.
References
Seventh INTERMACS annual report: 15,000 patients and counting. / J.K. Kirklin [et al.] // J Heart Lung Transplant. – 2015. – Vol. 34, suppl. 12. – P. 1495-1504.
Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost Analysis. / S.A. Akhter [et al.] // Ann Thorac Surg. – 2015. – Vol. 100, suppl. 3. – P. 884-889.
Morbidity and mortality in heart transplant candidates supported with mechanical circulatory support: is reappraisal of the current United network for organ sharing thoracic organ allocation policy justified? / O. Wever-Pinzon [et al.] // Circulation. – 2013. – Vol. 127,
iss. 4. – P. 452-462.
Nassif M., Raymer D., LaRue S., Chen C.H.. Video capsule endoscopy in left ventricular assist device recipients with obscure gastrointestinal bleeding. / S. Amornsawadwattana [et al.] // World J Gastroenterol. – 2016. – Vol. 22, iss. 18. – P. 4559-4566.
Evaluation of GI bleeding after implantation of left ventricular assist device. / V.M. Kushnir [et al.] // Gastrointest Endosc. – 2012. – Vol. 75, iss. 5. – P. 973-979.
Acquired von Willebrand syndrome in continuous-flow ventricular assist device recipients. / S. Crow [et al.] // Ann Thorac Surg. – 2010. – Vol. 90, iss. 4. – P. 1263-1269.
Acquired von Willebrand syndrome in patients with an axial flow left ventricular assist device. / A.L. Meyer [et al.] // Circ Heart Fail. – 2010. – Vol. 3, iss. 6. – P. 675-681.
H eartMate II Investigators. Advanced heart failure treated with continuous-flow left ventricular assist device. / M.S. Slaughter [et al.] // N Engl J Med. – 2009. – Vol. 361, iss. 23. – P. 2241-2251.
Antiplatelet Therapy and Adverse Hematologic Events During Heart Mate II Support. / O. Saeed [et al.] // Circ Heart Fail. – 2016. – Vol. 9, iss. 1. – e002296.
Major bleeding during HeartMate II support. / M.C. Bunte [et al.] // J Am Coll Cardiol. – 2013. – Vol. 62, iss. 23. – P. 2188-2196.
Pulsatility and the risk of nonsurgical bleeding in patients supported with the continuousflow left ventricular assist device HeartMate II. / O. Wever-Pinzon [et al.] // Circ Heart Fail. – 2013. – Vol. 6, iss. 3. – P. 517-526.
Low thromboembolism and pump thrombosis with the HeartMate II left ventricular assist device: analysis of outpatient anti-coagulation. / A.J. Boyle [et al.] // J Heart Lung Transplant. – 2009. – Vol. 28, iss. 9. – P. 881-887.
Relationship Between Anticoagulation Intensity and Thrombotic or Bleeding Outcomes Among Outpatients With Continuous-Flow Left Ventricular Assist Devices. / M.E. Nassif [et al.] // Circ Heart Fail. – 2016. – Vol. 9, iss. 5.
Stroke After Left Ventricular Assist Device Implantation: Outcomes in the Continuous-Flow Era. / L. Harvey [et al.] // Ann Thorac Surg. – 2015. – Vol. 100, iss. 2. – P. 535-541.
Stroke while on long-term left ventricular assist device support: incidence, outcome, and predictors. / J.A. Morgan [et al.] // ASAIO J. – 2014. – Vol. 60, iss. 3. – P. 284-289.
Preoperative atrial fibrillation may not increase thromboembolic events in left ventricular assist device recipients on midterm follow-up. / Y. Xia [et al.] // J Heart Lung Transplant. – 2016. – Vol. 35, iss. 7. – P. 906-912.
HVAD Bridge to Transplant ADVANCE Trial Investigators. An analysis of pump thrombus events in patients in the HeartWare ADVANCE bridge to transplant and continued access protocol trial. / S.S. Najjar [et al.] // J Heart Lung Transplant. – 2014. – Vol. 33, supp. 1. – P. 23-34.
Development of a novel echocardiography ramp test for speed optimization and diagnosis of device thrombosis in continuous-flow left ventricular assist devices: the Columbia ramp study. / N. Uriel [et al.] // J Am Coll Cardiol. – 2012. – Vol. 60, supp. 18. – P. 1764-1775.
PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management (PREVENT). / S. Maltais [et al.] // J Heart Lung Transplant. – 2016. – Vol. 35, iss. 4. – P. S161-S162.
Unexpected abrupt increase in left ventricular assist device thrombosis. / R.C. Starling [et al.] // N Engl J Med. – 2014. – Vol. 370, supp. 1. – P. 33-40.
Conservative approaches for HeartWare ventricular assist device pump thrombosis may improve the outcome compared with immediate surgical approaches. / D. Saeed [et al.] // Interact Cardiovasc Thorac Surg. – 2016. – Vol. 23, supp. 1. – P. 90-95.
Two-Year Outcomes with Magnetically Levitated Cardiac Pump in Heart Failure. / Mandeep R. Mehra [et al.] // New England Journal of Medicine. Онлайн- ресурс. Дата останнього відвідування 15 Травня 2019 р.
