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DOI: 10.1055/s-0032-1332547
New regimen for early postoperative anticoagulation in HeartWare ventricular assist device patients – is less more?!
Objectives: Implantation of a mechanical circulatory support system is one of the new therapy options in end-stage heart failure. The new HeartWare ventricular assist device system (HVAD), a magnetically levitated centrifugal blood pump, shows a low complication rate. Advantages of this new system are less hemolysis, reduced neurological and thromboembolic events, simplified implantation procedure and less bleedings based on lower levels of anticoagulation compared to pulsatile assist devices. Due to these facts we evaluated a new regimen for early postoperative anticoagulation.
Methods: Between 01/2010 and 06/2012 25 patients underwent HVAD implantation. Indications for assist device insertion were dilated cardiomyopathy in 12 (48%) patients, ischemic cardiomyopathy in 8 (32%) cases and myocarditis in 5 (20%) patients. No anticoagulation was conducted for the first twelve hours postoperatively. Then anticoagulation with oral phenprocoumon was started according to INR. No intravenous heparine bridging was performed. INR course was monitored from postoperative day one to five and early postoperative complications such as mortality, stroke, thrombosis and bleeding were observed.
Results: Mean patient age was 56.03 ± 12.10 years, all patients were male. When patients were transferred to ICU, an anticoagulation profile was taken. The first measured INR was 1.49 ± 0.57 (1.0 – 3.1). Mean dosage of first postoperative phenprocoumon administration was 6.25 ± 2.1 mg given according to measured INR. Mean INR level was 1.53 ± 0.77 (1.1 – 5.0) on day one, between day two and four mean INR was 1.44 ± 0.40 (0.8 – 2.5)/1.85 ± 1.06 (0.9 – 4.9)/2.03 ± 1.07 (0.9 – 5.0) and on day five mean INR level was 2.08 ± 1.03 (0.9 – 5.0). All patients survived the early postoperative period and no stroke, thrombosis, rethoracotomy, or major bleeding complication occurred. One minor gastrointestinal bleeding occurred in 1 (4%) patient.
Conclusion: Early postoperative anticoagulation regimen without heparin bridging can be performed safely, thereby avoiding potential bleeding complications due to the additive effects of phenprocoumon and heparine. Despite lower anticoagulation levels no stroke or thrombosis occurred in any of the patients.