Abstract Number: PB0275
Meeting: ISTH 2020 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
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.
| ANTICOAGULANT | UNH | LMWH | WARFARIN |
| 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% |
| ANTIPLATELETS THERAPY | ASPIRIN | CLOPIDOGREL | DIPYRIDAMOLE |
| 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.]
[Figure 1. Berlin Heart EXCOR protocol for adult patients from our centre.]
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.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thrombohemorragic-events-and-management-of-haemostasis-in-adult-patients-under-berlin-heart-excor-devices/