Impact of a modified anti-thrombotic guideline on stroke in children supported with a pediatric ventricular assist device

Rosenthal, David N.; Lancaster, Chacy A.; McElhinney, Doff B.; Chen, Sharon; Stein, M.L.; Lin, Aileen; Ðoàn, Lan; Murray, Jenna; Gowan, Mary Alice; Maeda, Keisuke; Reinhartz, Olaf; Almond, Christopher S.

doi:10.1016/j.healun.2017.05.020

Cited by 66 publications

(50 citation statements)

References 16 publications

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“…We used target dosing for antiplatelet agents rather than dosing based on platelet mapping: aspirin 30 mg/kg/d, clopidogrel 1 mg/kg/d, and dipyridamole 15 mg/kg/d divided q6 hours. The rationale for this change is summarized in our recently published paper on anticoagulation …”

Section: Methodsmentioning

confidence: 99%

Characteristics of deposits and pump exchange in the Berlin Heart EXCOR ventricular assist device: Experience with 67 cases

Maeda

Almond

Hollander

et al. 2018

Pediatric Transplantation

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Pump exchanges are frequently required in the Berlin Heart EXCOR VAD. We intended to describe the characteristics of pump deposits in a larger patient series and evaluate if changes in our exchange procedure over time have led to increased complications. We reviewed all EXCOR pump exchanges in our institution from July 2004 to October 2014. We gathered data on size and location of pump deposits and exchange procedures. EXCOR devices were implanted in 38 children. Support was LVAD only in 22, BiVAD in 13, and SVAD in 3 cases. Sixty-seven pumps were exchanged. The incidence of pump exchanges per month was higher for smaller pumps and for RVADs vs LVADs. Indications were visible pump deposit in 55, stroke without visible deposit in 5, incorporation of membrane oxygenator in 3, pump size change in 2, and sepsis in 1 case, respectively. Deposits were located in the outflow valve in 73%, inflow valve in 22%, pump body in 3%, and outflow cannula in 3%. EXCOR pumps are predominantly exchanged for deposits, which are most frequently located in the outflow valves. The procedure is now carried out without sedation at the bedside. No major complications were observed during exchanges.

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Section: Methodsmentioning

confidence: 99%

Characteristics of deposits and pump exchange in the Berlin Heart EXCOR ventricular assist device: Experience with 67 cases

Maeda

Almond

Hollander

et al. 2018

Pediatric Transplantation

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“…For patients with Berlin Heart EXCOR most institutions follow the Edmonton protocol for long‐term anticoagulation consisting of either low molecular weight heparin (LMWH) or warfarin instead of UFH infusion and 2 antiplatelets agents guided by thrombelastography platelet mapping and arachidonic acid inhibition. At Stanford Children's Hospital we use a modified protocol for Berlin Heart patients with the use of three antiplatelet agents (aspirin, dipyridamole and clopidogrel), in addition to LMWH and early results have shown a lower incidence of stroke rate compared with the use of two antiplatelet agents . For patients with CF devices we transition from UFH infusion to oral warfarin for long‐term anticoagulation in addition to a standard antiplatelet agent such as aspirin.…”

Section: Perioperative Management For Vad Implantationmentioning

confidence: 99%

“…31 If the preoperative INR is ≥2 we also administer an inac- to LMWH and early results have shown a lower incidence of stroke rate compared with the use of two antiplatelet agents. 32 For patients with CF devices we transition from UFH infusion to oral warfarin for long-term anticoagulation in addition to a standard antiplatelet agent such as aspirin. We also use omega 3 fatty acids for CF devices for its anti-platelet effects.…”

Section: Hemostasis and Vad Anticoagulation Regimensmentioning

confidence: 99%

Pediatric ventricular assist devices: Bridge to a new era of perioperative care

Navaratnam

Maeda

Hollander

2019

Pediatric Anesthesia

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Summary Pediatric ventricular assist devices (VADs) are evolving as a standard therapy for end stage heart failure in children. Major recent developments include the increased use of continuous flow (CF) devices in children and increased experience with congenital heart disease (CHD) and outpatient management. In the current and future era anesthesiologists will encounter more children presenting for VAD implantation, subsequent procedures and heart transplantation. Successful perioperative management requires an understanding of the interaction between the patient's physiology and the device and a framework to troubleshoot problems. This review focuses on CF devices, VAD support for CHD and perioperative management of pulsatile and CF devices in the pediatric population.

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“…However, aggressive antiplatelet therapy appears to be beneficial. One pediatric study using the Berlin Heart EXCOR VAD found that triple antiplatelet therapy (ASA, dipyramidole, and clopidogrel) using high, weight‐based dosing targets reduced stroke incidence by 84% compared with DAPT (ASA and dipyramidole), titrated based on thromboelastography (TEG) with platelet mapping . The triple therapy cohort experienced less significant bleeding as well.…”

Section: Aspirin Indication By Disease Subgroupmentioning

confidence: 99%

Aspirin in childhood acute ischemic stroke: The evidence for treatment and efficacy testing

Boucher

Taylor

Luchtman‐Jones

2019

Pediatric Blood & Cancer

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Aspirin is the most commonly prescribed antiplatelet agent worldwide, but evidence supporting its use varies by age and disease process. Despite its frequent use in childhood acute ischemic stroke prevention and management, major knowledge gaps exist about optimal pediatric aspirin use, particularly in this setting, where high‐quality clinical trials are urgently needed. This review focuses upon the evidence for aspirin use in childhood acute ischemic stroke, includes a summary of aspirin pharmacology to highlight misconceptions and common clinical situations which may limit its efficacy, and discusses the techniques and potential role of laboratory monitoring of aspirin efficacy in children.

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Impact of a modified anti-thrombotic guideline on stroke in children supported with a pediatric ventricular assist device

Cited by 66 publications

References 16 publications

Characteristics of deposits and pump exchange in the Berlin Heart EXCOR ventricular assist device: Experience with 67 cases

Characteristics of deposits and pump exchange in the Berlin Heart EXCOR ventricular assist device: Experience with 67 cases

Pediatric ventricular assist devices: Bridge to a new era of perioperative care

Aspirin in childhood acute ischemic stroke: The evidence for treatment and efficacy testing

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