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        Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock JACC Review Topic of the Week

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        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.
        Publication date
        2022-05-17
        Published in
        Journal of the American College of Cardiology
        Published version
        https://doi.org/10.1016/j.jacc.2022.02.052
        License
        http://creativecommons.org/licenses/by-nc-nd/4.0/
        Other links
        http://hdl.handle.net/2299/25520
        Relations
        School of Life and Medical Sciences
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