Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock: JACC Review Topic of the Week
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Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock: JACC Review Topic of the Week. / 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.
in: J AM COLL CARDIOL, Jahrgang 79, Nr. 19, 17.05.2022, S. 1949-1962.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock: JACC Review Topic of the Week
AU - Vandenbriele, Christophe
AU - Arachchillage, Deepa J
AU - Frederiks, Pascal
AU - Giustino, Gennaro
AU - Gorog, Diana A
AU - Gramegna, Mario
AU - Janssens, Stefan
AU - Meyns, Bart
AU - Polzin, Amin
AU - Scandroglio, Mara
AU - Schrage, Benedikt
AU - Stone, Gregg W
AU - Tavazzi, Guido
AU - Vanassche, Thomas
AU - Vranckx, Pascal
AU - Westermann, Dirk
AU - Price, Susanna
AU - Chieffo, Alaide
N1 - Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2022/5/17
Y1 - 2022/5/17
N2 - 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.
AB - 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.
KW - Anticoagulants/therapeutic use
KW - Critical Illness
KW - Heart-Assist Devices/adverse effects
KW - Hemorrhage/chemically induced
KW - Humans
KW - Retrospective Studies
KW - Shock, Cardiogenic/etiology
KW - Thrombosis/complications
KW - Treatment Outcome
U2 - 10.1016/j.jacc.2022.02.052
DO - 10.1016/j.jacc.2022.02.052
M3 - SCORING: Review article
C2 - 35550692
VL - 79
SP - 1949
EP - 1962
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 19
ER -