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.