Optimizing anticoagulation for patients receiving Impella support

Beavers, Craig J.; DiDomenico, Robert J.; Dunn, Steven P.; Cox, Jenna; To, Long Seng; Weeks, Phillip; Trujillo, Toby C.; Jennings, Douglas L.

doi:10.1002/phar.2629

Cited by 29 publications

(27 citation statements)

References 47 publications

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“… 5 , 6 , 15 Recent data suggest that the use of a bicarbonate-based purge solution (BBPS) is an alternative to heparin in Impella ™ purge fluid to prevent purge blockage. 16–18 …”

Section: Anticoagulant Strategies In Patients Undergoing Protected Pe...mentioning

confidence: 99%

“… 22 However, robust evidence to support use of a DTI in this setting is lacking 15 , 23 , 24 and it might even be detrimental. 16 , 24 , 25 …”

Section: The Role Of the Purge Solution And Anticoagulation With Unfr...mentioning

confidence: 99%

“…Unfractionated heparin has a highly negative ionic charge and plays a significant role in protecting the purge gaps; non-heparin anticoagulants lacking ionic charge should generally be avoided in the purge solution. 16 Although successful use of DTI has been described in case series, there is evidence that low purge flows with rising purge pressure, pump failure, and/or thrombosis with DTI-based purge solutions can occur. 15 , 16 , 22–25 , 36–38 Therefore, BBPS (25 mEq per 1000 mL in 5% of dextrose; same highly negative charge as UFH) may be preferred in scenarios when a heparin-based purge solution is not feasible, or HIT is present.…”

Section: Anticoagulation With Direct Thrombin Inhibitorsmentioning

confidence: 99%

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What is known in pre-, peri-, and post-procedural anticoagulation in micro-axial flow pump protected percutaneous coronary intervention?

Leick

Grottke

Oezkur³

et al. 2022

European Heart Journal Supplements

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Interest in the use of percutaneous left ventricular assist devices (p-LVADs) for patients undergoing high-risk percutaneous coronary intervention (PCI) is growing rapidly. The Impella™ (Abiomed Inc.) is a catheter-based continuous micro-axial flow pump that preserves haemodynamic support during high-risk PCI. Anticoagulation is required to counteract the activation of the coagulation system by the patient’s procoagulant state and the foreign-body surface of the pump. Excessive anticoagulation and the effect of dual antiplatelet therapy (DAPT) increase the risk of bleeding. Inadequate anticoagulation leads to thrombus formation and device dysfunction. The precarious balance between bleeding and thrombosis in patients with p-LVAD support is often the primary reason that patients’ outcomes are jeopardized. In this chapter, we will discuss anticoagulation strategies and anticoagulant management in the setting of protected PCI. This includes anticoagulant therapy with unfractionated heparin, direct thrombin inhibitors, DAPT, purge blockage prevention by bicarbonate-based purge solution, and monitoring by activated clotting time, partial thromboplastin time, as well as anti-factor Xa levels. Here, we provide a standardized approach to the management of peri-interventional anticoagulation in patients undergoing protected PCI.

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“… 5 , 6 , 15 Recent data suggest that the use of a bicarbonate-based purge solution (BBPS) is an alternative to heparin in Impella ™ purge fluid to prevent purge blockage. 16–18 …”

Section: Anticoagulant Strategies In Patients Undergoing Protected Pe...mentioning

confidence: 99%

“… 22 However, robust evidence to support use of a DTI in this setting is lacking 15 , 23 , 24 and it might even be detrimental. 16 , 24 , 25 …”

Section: The Role Of the Purge Solution And Anticoagulation With Unfr...mentioning

confidence: 99%

Section: Anticoagulation With Direct Thrombin Inhibitorsmentioning

confidence: 99%

See 1 more Smart Citation

What is known in pre-, peri-, and post-procedural anticoagulation in micro-axial flow pump protected percutaneous coronary intervention?

Leick

Grottke

Oezkur³

et al. 2022

European Heart Journal Supplements

View full text Add to dashboard Cite

show abstract

“…Impella systems ® require a heparinized dextrose-based purge solution and systemic heparinization with ACT around 160-160 seconds for its proper functioning. A recent publication by Beavers [15] proposes variations of the purge solution that can be modified depending on the patients' status.…”

Section: Anticoagulationmentioning

confidence: 99%

Heart Transplant after Mechanical Circulatory Support

Sandoval¹,

Pereda²

2022

Heart Transplantation - New Insights in Therapeutic Strategies

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Heart transplant is the gold-standard treatment for end-stage heart failure. However, the aging of the population, increase in the prevalence of heart failure and the shortage of available donors have led to a significant increase in the wait-list times. This increase in waiting time may cause some patients clinically deteriorate while on the list. Several bridging strategies have been developed to help patients reach heart transplant. It is mandatory to know the current results of these techniques and the specific tips and tricks these different devices may have. Survival results would also be presented to help us decide the best strategy for each of our patients.

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“… Lee E4 2021 JACC Cardiovasc Interv. Management of anticoagulation Beavers E5 2021 Pharmacotherapy. Rivosecchi E6 2021 Crit Care Med.…”

Section: Appendixmentioning

confidence: 99%

Algorithmic management of postcardiotomy shock with mechanical support: Bring a map, a plan, and your parachute—and know how to use all three

Stein

Silvestry²

2021

JTCVS Open

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Optimizing anticoagulation for patients receiving Impella support

Cited by 29 publications

References 47 publications

What is known in pre-, peri-, and post-procedural anticoagulation in micro-axial flow pump protected percutaneous coronary intervention?

What is known in pre-, peri-, and post-procedural anticoagulation in micro-axial flow pump protected percutaneous coronary intervention?

Heart Transplant after Mechanical Circulatory Support

Algorithmic management of postcardiotomy shock with mechanical support: Bring a map, a plan, and your parachute—and know how to use all three

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