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DOI: 10.1055/s-2004-816706
Coagulation management in patients with an implantable axial flow left ventricular assist device
Objectives: Due to increased use of implantable axial assist devices, a safe, inexpensive and easily performed coagulation management was introduced in our institution for patients on the axial flow pump Berlin Heart Incor.
Material and Methods: Between June 2002 and September 2003 this new axial flow pump was implanted in 30 patients. The diagnosis in 23 patients was dilatative cardiomyopathy (CMP), in six ischemic CMP and in one restrictive CMP. The group was treated with a new anticoagulation concept consisting of anti-aggregation, anti-adhesion and anti-coagulation drugs and of rheologica. The mean support time was 141 days (range 23–444 days).
Results: After the first two postoperative days the mean platelet count was over 100,000/µl and results in platelet aggregation tests were normal, so that early anti-aggregation therapy was necessary. Nevertheless one patient suffered a transient ischemic attack (TIA) on the eighth postoperative day. In total, three TIAs occurred in two patients and three cases of apoplexy were seen. In three patients left atrial thrombus occurred, leading to apoplexy in two; in both, self-medication was erroneous. One of them died and the other had intracerebral bleeding, needing trepanation. Two of the patients had to be reopened, four had gastrointestinal bleeding and three patients had transient epistaxis.
Conclusions: With the new axial flow pump Berlin Heart Incor early postoperative platelet recovery was seen, requiring early anti-aggregation therapy. Our coagulation protocol minimized bleeding and embolic complications. It ensures the survival of patients on axial flow pumps and enables them to be discharged home.