10027/22853
J. Erin Allender
J. Erin
Allender
Brent N. Reed
Brent N.
Reed
Jenna L. Foster
Jenna L.
Foster
Jeremy D. Mortez
Jeremy D.
Mortez
Carrie S. Oliphant
Carrie S.
Oliphant
Douglas L. Jennings
Douglas L.
Jennings
Robert J. DiDomenico
Robert J.
DiDomenico
James C. Coons
James C.
Coons
Pharmacologic Considerations in the Management of Patients Receiving Left Ventricular Percutaneous Mechanical Circulatory Support
University of Illinois at Chicago
2018
anticoagulation
percutaneous ventricular assist device
Impella
TandemHeart
intraaortic balloon pump
cardiogenic shock
patient safety
2018-11-20 00:00:00
Journal contribution
https://indigo.uic.edu/articles/journal_contribution/Pharmacologic_Considerations_in_the_Management_of_Patients_Receiving_Left_Ventricular_Percutaneous_Mechanical_Circulatory_Support/10777004
Percutaneous mechanical circulatory support (MCS) devices, including the intra-aortic balloon pump, Impella, and TandemHeart, are often used for hemodynamic support in the setting of refractory cardiogenic shock. The thrombotic and bleeding complications associated with these devices is well recognized, and the Impella and TandemHeart devices have unique anticoagulation considerations that may influence patient outcomes. Both devices typically require use of a heparinized purge solution in combination with intravenous unfractionated heparin, thereby providing multiple sources of heparin exposure. Each device also has specific monitoring requirements and goal ranges. The purpose of this review is to provide an overview of percutaneous MCS devices commonly used in the acute management of left ventricular failure, with an emphasis on pharmacologic considerations. We review recent evidence and guidelines and provide recommendations for appropriate use of anticoagulation during device support. Approaches to managing heparinized purge solutions, monitoring, and the utility of nonheparin anticoagulants are also provided, as high-quality evidence in the literature is limited.