Andrea Sikora Newsome1,2, Ashley Taylor1,2, Seth Garner1. 1. Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA. 2. Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.
Abstract
BACKGROUND: Impella CP® is a percutaneous left ventricular assist device that requires a heparin-dextrose purge solution. The manufacturer recommends heparin 50 units/mL, but supratherapeutic anticoagulation has been observed with this concentration. OBJECTIVE: The purpose of this evaluation was to observe the efficacy and safety of a low-dose heparin-based purge solution (25 units/mL in dextrose 20%). The primary outcome evaluated percentage of activated clotting times (ACTs) below therapeutic range. Secondary objectives included evaluating the incidence of device thrombosis and rate of heparin-induced thrombocytopenia (HIT). Platelet trends were characterized. METHODS: A single-site retrospective review was conducted for all adults with the Impella CP from January 2015 to December 2017. RESULTS: A total of 18 patients were included. The percentage of ACT readings within goal of 160 to 200 seconds was 49%, and 38% of readings were subtherapeutic. Per BARC bleeding criteria, 22% (n = 4) patients experienced class IIIa bleeding and 39% (n = 7) experienced class II bleeding. Though 4 (22%) patients were tested for HIT, no patients were positive. Patients showed universal reductions in platelet counts. CONCLUSIONS: The use of a low-dose anticoagulation protocol of heparin 25 units/mL in dextrose 20% as needed warrants further evaluation.
BACKGROUND:Impella CP® is a percutaneous left ventricular assist device that requires a heparin-dextrose purge solution. The manufacturer recommends heparin 50 units/mL, but supratherapeutic anticoagulation has been observed with this concentration. OBJECTIVE: The purpose of this evaluation was to observe the efficacy and safety of a low-dose heparin-based purge solution (25 units/mL in dextrose 20%). The primary outcome evaluated percentage of activated clotting times (ACTs) below therapeutic range. Secondary objectives included evaluating the incidence of device thrombosis and rate of heparin-induced thrombocytopenia (HIT). Platelet trends were characterized. METHODS: A single-site retrospective review was conducted for all adults with the Impella CP from January 2015 to December 2017. RESULTS: A total of 18 patients were included. The percentage of ACT readings within goal of 160 to 200 seconds was 49%, and 38% of readings were subtherapeutic. Per BARC bleeding criteria, 22% (n = 4) patients experienced class IIIa bleeding and 39% (n = 7) experienced class II bleeding. Though 4 (22%) patients were tested for HIT, no patients were positive. Patients showed universal reductions in platelet counts. CONCLUSIONS: The use of a low-dose anticoagulation protocol of heparin 25 units/mL in dextrose 20% as needed warrants further evaluation.
Entities:
Keywords:
anticoagulation; cardiogenic shock; left ventricular assist device
Authors: Yukiharu Sugimura; Sebastian Bauer; Moritz Benjamin Immohr; Arash Mehdiani; Philipp Rellecke; Ralf Westenfeld; Hug Aubin; Udo Boeken; Artur Lichtenberg; Payam Akhyari Journal: Front Cardiovasc Med Date: 2022-07-07