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Management of Antithrombotic Treatment and Thrombohaemorragic Events in Children under Berlin Heart Excor Devices

M. Arguello-Tomas1, R. Gomez-Antonio1, M.J Santiago1, G. Pérez Rus1,2, J.L. Diez-Martin2,3,1, C. Pascual Izquierdo1,3

1Gregorio Marañón Hospital, Madrid, Spain, 2Complutense University of Madrid, Madrid, Spain, 3Instituto de Investigación de Salud Gregorio Marañon, Madrid, Spain

Abstract Number: PB0790

Meeting: ISTH 2021 Congress

Theme: Pediatrics » Thrombosis in Neonates and Children

Background: Berlin-Heart EXCOR (BHE) is a ventricular assist device (VAD) used as bridge to cardiac transplantation. Thrombohaemorragic events (THE) are the most life-threatening complications, so close monitorization is needed.

Aims: Our goal was describing THE and antithrombotic monitoring results in our experience.

Methods: Eighteen paediatric patients undergoing BHE between 2009-2020 were identified. One patient receiving cardiac transplant the same day that BHE was implanted was excluded of statistical analysis. Median age was 15.9 months (4.6-43.6) and 66.7% were male. Three-hundred and ninety-seven haemostatic controls (blood count, basic and special coagulation tests) based in our protocol (Figure 1) were included: every 24 hours first week, every 3-7 days from then and at the time and in previous 48 hours before any THE.

Berlin Heart EXCOR protocol for paediatric patients from our centre.

Results: Haemostasia tests controls are resumed in Table 1. Anticoagulation based on low molecular weight heparin (LMWH) was the longest used anticoagulation therapy (p=0.002), and a lower rate of thrombocytopenia (p=.0019) and higher rate (p=0.011) and days (p=0.002) under therapeutical range was observed. Only 38.3% of Multiplate® tests results were in correct range, both similar in ADP and ASPI tests. 
Forty THE occurred with a median of 2THE (1-3) per patient. Bleeding was the most frequent (52.5%), followed by BHE thrombosis (30%). Clinical thrombosis was the less frequent (17.5%); all of them were ischemic stroke. Bleeding was the earliest complication complication (p=0.0023). Previous to each THE, just in 42.9% there was a haemostatic state in blood controls that explained the event, so other factors not related to haemostasis must be considered.
The 66.7% of patients were successfully bridged to cardiac transplantation. Five patients (27.8%) died while on a device, but only one because a THE (bleeding).

Anticoagulant Unfractioned Heparin Low-Molecular Weight Heparin Warfarin
Days from BHE implantation 1 (1-1,5) 9 (7.5-31.5) 8 (6-15)
Duration (days) 13 (6.5-28) 34 (2-94) 25 (1-32)
Days to first test on range 3 (3-4.5) 1 (1-8) 2 (1-6)
Normal range values RAPTT 2-2.5 Axa 0.6-1 INR 2-3
Tests on range 48.1% 67.2% 53.5%

Anticoagulant and haemostasis tests controls in our patients. Results are medians, interquartile range and percentages.

Conclusions: Protocolized anticoagulation and antiplatelets monitoring allows focused management of these patients and could have diminished life-threating THE. LWMH could offer better therapeutical stability, but not less THE.

To cite this abstract in AMA style:

Arguello-Tomas M, Gomez-Antonio R, J Santiago M, Pérez Rus G, Diez-Martin JL, Pascual Izquierdo C. Management of Antithrombotic Treatment and Thrombohaemorragic Events in Children under Berlin Heart Excor Devices [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/management-of-antithrombotic-treatment-and-thrombohaemorragic-events-in-children-under-berlin-heart-excor-devices/. Accessed June 25, 2022.

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