Abstract Number: PB0275
Meeting: ISTH 2020 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 aim was describing THE and antithrombotic monitoring results in our experience.
Methods: 15 adult patients undergoing BHE between 2009-2019 were identified. Median age was 57 years old (27-70) and 93% were male. 422 haemostatic controls (blood count, basic and special coagulation tests) based in our clinical protocol (Figure 1) were included: every 24h first week, every 3-7 days from then and at the time and in previous 48h before any THE.
Results: Anticoagulation based on low molecular weight heparin (LMWH) and warfarin showed lower rate of anaemia (p< 0.001) and thrombocytopenia (p < 0.001) and better rate of anticoagulation (p< 0.001), antiplatelets (p< 0.001) and therapy stability (p< 0.001) (Table 1) than with unfractioned heparin (UFH). Antithrombotic stability (p< 0.001) was higher under LMWH than warfarin. 35.8% Multiplate® antiaggregation controls under dipyridamole, aspirin and clopidogrel were on range. No statistical differences on THE number were found between any anticoagulation (p=0293) nor antiplatelets (p=0.94) therapy.
56 THE occurred with a median of 4 THE (1-7) per patient. Bleeding was the most frequent (46.4%), followed by BHE thrombosis (39.3%). Clinical thrombosis was the less frequent (14.3%); all of them were ischemic stroke and 42.8% of haemostatic controls in previous 48 hours were in infratherapeutic range.
Median duration of BHE support was 105 days (18-194); 80% patients were successfully bridged to cardiac transplantation. 3 patients died while on a device: 1 because sepsis and 2 because neurological bleeding (both had severe coagulopathy previously diagnosed before BHE implantation).
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.
|Days from BHE implantation||1 (1-3)||42 (10-102)||32 (2-99)|
|Duration (days)||24.5 (7-59)||50.8 (6-147)||31 (2-99)|
|Days to first test on range||4 (2-31)||9.5 (1-35)||5 (2-15)|
|Normal range values||rate APTT 2-2.5 Anti-Xa 0.35-0.6||Anti-Xa 0.6-1||INR 3-3.5|
|Tests on range||29.6%||60.3%||62.1%|
|Normal multiplate range||ASPI 10-20 UI||ADP 20-35 UI||.|
|tests on range||52.8%||71.4%||.|
[Haemostatic tests results. Median, ranges and percentages are used Med = median, UNH = Unfractioned heparin, LMWH = Low molecular weight heparin.]
To cite this abstract in AMA style:Argüello M, Zatarain E, Pérez-Rus G, Sousa I, Valero MJ, Velásquez J, Martínez-Sellés M, Diez-Martin JL, Ortiz C, Pascual C. Thrombohemorragic Events and Management of Haemostasis in Adult Patients under Berlin Heart Excor Devices [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/thrombohemorragic-events-and-management-of-haemostasis-in-adult-patients-under-berlin-heart-excor-devices/. Accessed October 2, 2023.
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