Medizinische Universität Graz - Research portal
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SHR Neuro Cancer Cardio Lipid Metab Microb
Sandner, SE; Riebandt, J; Haberl, T; Mahr, S; Rajek, A; Schima, H; Wieselthaler, GM; Laufer, G; Zimpfer, D.
Low-molecular-weight heparin for anti-coagulation after left ventricular assist device implantation.
J Heart Lung Transplant. 2014; 33(1):88-93
Doi: 10.1016/j.healun.2013.10.009
Web of Science
PubMed
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- Co-authors Med Uni Graz
- Zimpfer Daniel
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- Abstract:
- BACKGROUND: Anti-coagulation is required in patients with left ventricular assist devices (LVADs). We evaluated the feasibility of low-molecular-weight heparin (LMWH) for initiation of anti-coagulation and transitioning to oral anti-coagulation after LVAD implantation. METHODS: This single-center study included 78 consecutive patients who underwent either Thoratec HeartMate II LVAD (n = 27) or HeartWare ventricular assist device (HVAD, n = 51) implantation. The LMWHs enoxaparin (n = 50) and dalteparin (n = 28) were used. LMWH was started within 24 hours post-operatively in 79.5% of patients. No anti-coagulation was given before starting LMWH therapy. LMWH activity was monitored by determination of anti-factor Xa levels in plasma. RESULTS: The majority of patients (80.7%) had peak anti-Xa activity within the defined range of efficacy of 0.2 to 0.4 IU/ml by the second day of treatment. Mean effective peak anti-Xa activity was 0.28 ± 0.06 IU/ml. Mean duration of anti-coagulation with LMWH was 25.8 ± 18 days. Ischemic strokes were observed in 3 patients (3.8%), with a total of 4 events. Three events occurred while on LMWH, and 1 event occurred during follow-up on oral anti-coagulation. There was 1 fatal stroke. No pump thrombus was observed. Major bleeding was observed in 5 patients (6.4%), with a total of 6 events. Gastrointestinal bleeding was the most common complication (n = 3). There were no fatal bleeding events. CONCLUSIONS: LMWH in the setting of LVAD shows rapid and constant biologic efficacy. Anti-coagulation with LMWH appears feasible after LVAD implantation. These findings support further evaluation of LMWH as an alternative to unfractionated heparin in this patient cohort.
- Find related publications in this database (using NLM MeSH Indexing)
- Aged - administration & dosage
- Anticoagulants - adverse effects, therapeutic use
- Cohort Studies - administration & dosage
- Feasibility Studies - administration & dosage
- Female - administration & dosage
- Heart Failure - therapy
- Heart-Assist Devices - adverse effects
- Hemorrhage - epidemiology, etiology
- Heparin, Low-Molecular-Weight - adverse effects, therapeutic use
- Humans - administration & dosage
- Incidence - administration & dosage
- Male - administration & dosage
- Middle Aged - administration & dosage
- Outcome Assessment, Health Care - administration & dosage
- Retrospective Studies - administration & dosage
- Risk Factors - administration & dosage
- Thrombosis - etiology, prevention & control
- Treatment Outcome - administration & dosage
- Ventricular Dysfunction, Left - therapy
- Find related publications in this database (Keywords)
- anti-coagulation
- low-molecular-weight
- ventricular assist device
- heart failure