Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock JACC Review Topic of the Week
Author
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
Attention
2299/25520
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.