Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Dec;7(12):2129-38.
doi: 10.3978/j.issn.2072-1439.2015.10.65.

Anticoagulation management in mechanical circulatory support

Sirtaz Adatya  1 , Mosi K Bennett  1
Affiliations
Review

Anticoagulation management in mechanical circulatory support

Sirtaz Adatya et al. J Thorac Dis. 2015 Dec.

Abstract

Heart failure continues to be a worldwide epidemic, effecting over 23 million persons. Despite advances in medical therapy, the disease is progressive and a significant proportion of patients will need advanced heart replacement therapy. Continuous flow assist devices have become a standard approach for many patients both as a bridge to cardiac transplantation and as destination therapy (DT). However, device related complications such as bleeding and thrombosis continue to hinder further advancements of this technology. The field is rapidly advancing and efforts to reduce pump complications are directed towards improving hemocompatibility and maximizing blood flow without clinically significant hemolysis, areas of stasis or turbulent flow.

Keywords: Anticoagulation; acquired von Willebrand syndrome; anti-factor Xa (anti-FXa); continuous-flow left ventricular assist device (CF-LVAD); device thrombosis; mean arterial pressure; mechanical circulatory support.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Trends in patient profiles, left ventricular assist device volumes, and management strategies, 2008-2013 [(Reprinted with permission) (24)]. AV, aortic valve; BTT, bridge to transplant; DT, destination therapy; FDA, Food and Drug Administration; GI, gastrointestinal; HMII, HeartMate II; HVAD, HeartWare Ventricular Assist Device; INTERMACS, Interagency Registry for Mechanically Assisted Circulatory Support; LVAD, left ventricular assist device; vWF, von Willebrand factor.
Figure 2
Figure 2
Multivariable risk factors for bleeding, hemorrhagic stroke, ischemic stroke, and pump thrombosis. Hazard rations for severe thrombotic and hemorrhagic events [(Reprinted with permission) (25)]. BMI, body mass index; HCT, hematocrit.
Figure 3
Figure 3
Anti-factor Xa (anti-FXa) determines anticoagulant activity by measuring the ability of the heparin-antithrombin complex to inhibit activated coagulation factor X. Measuring the inhibition of a single enzyme is a more direct measure of unfractionated heparin (UFH) activity than activated partial thromboplastin time (aPTT), which assesses the intrinsic coagulation and final common pathway [(Reprinted with permission) (32)].
See this image and copyright information in PMC

References

    1. Starling RC, Moazami N, Silvestry SC, et al. Unexpected abrupt increase in left ventricular assist device thrombosis. N Engl J Med 2014;370:33-40. - PubMed
    1. Kirklin JK, Naftel DC, Kormos RL, et al. Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device. J Heart Lung Transplant 2014;33:12-22. - PubMed
    1. Najjar SS, Slaughter MS, Pagani FD, et al. An analysis of pump thrombus events in patients in the HeartWare ADVANCE bridge to transplant and continued access protocol trial. J Heart Lung Transplant 2014;33:23-34. - PubMed
    1. Pagani FD, Milano CA, Tatooles AJ, et al. HeartWare HVAD for the Treatment of Patients With Advanced Heart Failure Ineligible for Cardiac Transplantation: Results of the ENDURANCE Destination Therapy Trial. ISHLT 35th Annual Meeting. Nice, France, 2015.
    1. Food and Drug Administration. Serious Adverse Events with Implantable Left Ventricular Assist Devices (LVADs): FDA Safety Communication. Available online: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm457327.htm