Abstract Number: PB0790
Meeting: ISTH 2021 Congress
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 November 27, 2021.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/management-of-antithrombotic-treatment-and-thrombohaemorragic-events-in-children-under-berlin-heart-excor-devices/