Anticoagulation of a Percutaneous Left Ventricular Assist Device Using a Low-Dose Heparin Purge Solution Protocol: A Case Series

Newsome, Andrea Sikora; Taylor, A. E.; Garner, Seth

doi:10.1177/0897190018822105

Cited by 15 publications

(16 citation statements)

References 13 publications

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“…In contrast, Impella had nonsignificantly higher rates of vascular complication compared with no MCS. Maintaining high activated clotting time (160 s‐200 s) and the bigger size sheath could lead to higher bleeding risk among patients with Impella 35 . Futhermore, other complications including sepsis 23 could have potentially mitigated the benefit of Impella 28 .…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of mechanical circulatory support with Impella or intra‐aortic balloon pump for high‐risk percutaneous coronary intervention and/or cardiogenic shock: Insights from a network meta‐analysis of randomized trials

Kuno

Takagi

Ando

et al. 2020

Cathet Cardio Intervent

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Background Mechanical circulatory support (MCS) with Impella or intra‐aortic balloon pump (IABP) is used for high‐risk percutaneous coronary intervention (PCI) and/or for cardiogenic shock (CS) due to acute myocardial infarction. We aimed to investigate the efficacy and safety of Impella or IABP when compared with no MCS using a network meta‐analysis of randomized controlled trials (RCTs). Methods EMBASE and MEDLINE were searched through February 2020 for RCT evaluating efficacy of Impella vs. IABP vs. no MCS in patients undergoing high‐risk PCI or CS. The primary efficacy outcome was 30 day or in‐hospital all‐cause mortality whereas the primary safety outcomes were major bleeding and vascular complications. Results Our search identified nine RCTs enrolling a total of 1,996 patients with high‐risk PCI and/or CS. There was no significant difference with Impella or IABP on all‐cause mortality when compared with no MCS (Impella vs. no MCS; OR:0.82 [0.35–1.90], p = .65, IABP vs. no MCS; OR:0.77 [0.47–1.28], p = .31, I2 = 18.1%). Impella significantly increased major bleeding compared with no MCS (Impella vs. no MCS; OR:7.01 [1.11–44.4], p = .038, I2 = 19.2%). IABP did not increase the risk of major bleeding compared with no MCS (OR:1.27 [0.75–2.16], p = .38, I2 = 19.2%) but increased vascular complication compared with no MCS (OR:1.92 [1.01–3.64], p = .045, I2 = 1.5%). Conclusions Neither Impella nor IABP decreased all‐cause short‐term mortality when compared with no MCS for high‐risk PCI and/or CS. Moreover, Impella increased major bleeding compared with no MCS.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of mechanical circulatory support with Impella or intra‐aortic balloon pump for high‐risk percutaneous coronary intervention and/or cardiogenic shock: Insights from a network meta‐analysis of randomized trials

Kuno

Takagi

Ando

et al. 2020

Cathet Cardio Intervent

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“…Depending on individual cases, we ought to decide on the ideal anticoagulation therapy. Previous studies underline the value of optimal anticoagulation therapy in a balance of prevention of thrombosis and the adverse result of major bleeding, respectively (1,(12)(13)(14)(15)(16). Despite the manufacturer's recommendation of anticoagulation management using ACT, systemic anticoagulation has been monitored by aPTT in the majority of past studies (aPTT > 45 s).…”

Section: Discussionmentioning

confidence: 99%

Outcome of Patients Supported by Large Impella Systems After Re-implantation Due to Continued or Recurrent Need of Temporary Mechanical Circulatory Support

Sugimura

Bauer²,

Immohr³

et al. 2022

Front. Cardiovasc. Med.

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Despite the growing utilization of a large microaxial pump, i. e., Impella 5.0 or 5.5 (Abiomed Inc., Danvers, MA, USA) (Impella 5+) for patients with cardiogenic shock (CS), adverse events including the necessity of re-implantation have not been well discussed. In all 67 patients, in-hospital mortality was 52.2% (n = 35). Explantation of Impella 5+ was performed in 39 patients (58.2%), 22 of whom (32.8%) recovered under Impella 5+, and ten further patients (14.9%) survived after a successful transition to permanent mechanical circulatory support. Embolic events were considerable complications in each access. They occurred in the right arm after the removal of Impella 5+ via a subclavian artery (SA) (n = 3, 9.1%) or in the form of leg ischemia in patients with Impella 5+ via femoral artery (FA) (n = 2, 33.3%). Re-implantation was necessary for 10 patients (14.9%) due to 1) recurrent CS (n = 3), 2) pump thrombosis (n = 5), or 3) pump dislocation (n = 2), all of which were successfully performed via the same access route. In univariate analysis, FA access was a significant risk factor for Impella dysfunction compared to SA access (FA vs. SA, 42.9% vs. 9.8%, p < 0.05, odds ratio 6.88). No statistical difference of overall mortality was observed in patients with Impella 5+ re-implantation (n = 10) compared to patients with primary Impella 5+ support (n = 57) (80.0% (n = 8/10) vs. 47.4% (n = 27/57), p = 0.09). Our results suggested the acceptable clinical outcome of Impella 5+ despite a 15% re-implantation rate. Our observational data may merit further analysis of anticoagulation strategies, including risk stratification for embolic events.

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“…However, heparin 25 unit/ml solutions appear to provide adequate protection for the pump while minimizing the potential for supratherapeutic anticoagulation when used with the less viscous D5W solution. 20,[23][24][25] As discussed above, purge flow rates are expected to decrease with more viscous (high dextrose content) solutions, and therefore, the amount of Impella-delivered heparin would be affected (Table 1). It should also be noted that the amount of anticoagulation contributed by the purge solution cannot be externally titrated or managed by the medical team.…”

Section: Recommendationsmentioning

confidence: 99%

Optimizing anticoagulation for patients receiving Impella support

Beavers

DiDomenico²,

Dunn

et al. 2021

Pharmacotherapy

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Cardiogenic shock is a complication experienced by 1-10% of patients hospitalized for either acute myocardial infarction or acute heart failure that leads to hypoperfusion of vital organs and contributes to an in-hospital mortality rate of up to 51%. [1][2][3][4] Temporary mechanical circulatory support (MCS) is often utilized in patients with cardiogenic shock to provide hemodynamic support. Although several temporary MCS options are available, the proportion of critically ill patientsincluding those with cardiogenic shock-receiving temporary MCS

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Anticoagulation of a Percutaneous Left Ventricular Assist Device Using a Low-Dose Heparin Purge Solution Protocol: A Case Series

Cited by 15 publications

References 13 publications

Safety and efficacy of mechanical circulatory support with Impella or intra‐aortic balloon pump for high‐risk percutaneous coronary intervention and/or cardiogenic shock: Insights from a network meta‐analysis of randomized trials

Safety and efficacy of mechanical circulatory support with Impella or intra‐aortic balloon pump for high‐risk percutaneous coronary intervention and/or cardiogenic shock: Insights from a network meta‐analysis of randomized trials

Outcome of Patients Supported by Large Impella Systems After Re-implantation Due to Continued or Recurrent Need of Temporary Mechanical Circulatory Support

Optimizing anticoagulation for patients receiving Impella support

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