Coagulation management in patients undergoing mechanical circulatory support

Görlinger, Klaus; Bergmann, Lars; Dirkmann, Daniel

doi:10.1016/j.bpa.2012.04.003

Cited by 75 publications

(42 citation statements)

References 204 publications

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“…Knowledge about the material induced outside-in signal transduction may allow new material design approaches, which could provide improved hemocompatible surfaces. In the clinical situation, this could enable cessation or at least dose reductions of anti-platelet/anticoagulatory treatment regimens like for example after coronary artery stenting, where platelet inhibitors are administered or in ventricular assist devices (VAD) patients, where heparin, warfarin, phenprocoumon and platelet inhibitors are employed [118,119]. Thereby, life-threatening bleeding complications in these patient groups could be strongly reduced.…”

Section: Hemocompatibility Testingmentioning

confidence: 99%

Are there sufficient standards for the in vitro hemocompatibility testing of biomaterials?

et al. 2013

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Section: Hemocompatibility Testingmentioning

confidence: 99%

Are there sufficient standards for the in vitro hemocompatibility testing of biomaterials?

et al. 2013

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“…39 Despite the fact that anticoagulant therapy as well as antiplatelet therapy is titrated in accordance to laboratory findings (of which some are bedside suitable), the combined rate of bleeding and thrombotic events is still high (up to 45%). 23 Platelet function test values may change over time with high intra-and interindividual variability [40][41][42] and it is possible that some patients on MCS therapy have resistance to antiplatelet therapy. 37,38,[43][44][45] …”

Section: Thoracic and Cardiovascular Surgeonmentioning

confidence: 99%

“…Measurement of factor XIII activity may be performed by conventional testing and indirectly by rotational thromboelastometry. 23 In cases of factor XIII deficiency, substitution of factor XIII (Fibrogammin, Marburg, Germany) should be considered with an aim to achieve factor XIII activity above 60 to 70%. [23][24][25] …”

Section: Acquired Von Willebrand Deficiencymentioning

confidence: 99%

Bleeding and Thrombotic Events in Patients Undergoing Mechanical Circulatory Support: A Review of Literature

Petričević

Miličić

Boban

et al. 2015

Thorac cardiovasc Surg

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Bleeding and thrombotic events are among the most common complications detected in patients with mechanical circulatory support (MCS). Herein, we reviewed the available evidence on the prevalence, etiology, and management of bleeding and thrombotic events in patients following MCS procedures, such as implantation of both intra- and paracorporeal devices that generate either pulsatile or nonpulsatile flow. Extracorporeal life support procedures providing support to the failing heart and lungs were also reviewed. Most bleeding and thromboembolic events occur despite appropriate hemostatic and anticoagulation management based on conventional coagulation laboratory parameters. Prevalence of bleeding events in this population ranges between 5 and 81%. Wide range in prevalence of bleeding reported in literature may be explained by different devices with different anticoagulation protocols being used, as well as different definitions of bleeding outcomes. Although bleeding events are more common than thromboembolic events, the consequences of thrombotic events are often detrimental. Management of bleeding events remains challenging and measures to prevent and treat bleeding events are often followed by thromboembolic events. Therefore, a personalized approach based on point-of-care hemostatic tests and adjusted to device type and patient comorbidities is therefore warranted. To provide advanced understanding of hemostatic disturbances during MCS, prospective trials focused on bleeding and thromboembolic events as primary endpoints should be conducted. Better understanding of the underlying pathophysiology and a shift towards a personalized approach based on functional point-of-care hemostatic properties assessment may provide more favorable clinical outcomes. This should, however, be coupled with further technological improvements providing better device surface hemocompatibility as interaction between blood and device surface affects the hemostatic equilibrium.

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“…Our fi ndings support those of a recently published retrospective study by Gorlinger et al [15] that included 3,865 cardiac surgery patients in whom POC testing combined with fi rst-line administration of coagulation factor concentrates was as sociated with decreased incidence of blood transfusion and adverse events. In ICU patients undergoing mechanical circulatory support, monitoring of hemostasis using POC thromboelastometry/-graphy and platelet function analysis is also recommended to reduce the risk of bleeding and thromboembolic complications [4]. Notably, these hemostatic tests should be performed repeatedly during mechanical circulatory support therapy since thrombin generation, clot fi rmness and platelet response may change signifi cantly over time with marked inter-and intra-individ ual variability.…”

Section: Cardiovascular Surgerymentioning

confidence: 99%

“…In patients with extracorporeal life support (ventricul ar-assis t devices, extracor poreal membrane oxygenation [4] ), the risk of coagulopathy is further increased by:…”

Section: Diagnosis Of Coagulopathy In Intensive Care Medicinementioning

confidence: 99%