Allender_et_al-2017-Pharmacotherapy__The_Journal_of_Human_Pharmacology_and_Drug_Therapy.pdf (568.07 kB)
0/0

Pharmacologic Considerations in the Management of Patients Receiving Left Ventricular Percutaneous Mechanical Circulatory Support

Download (568.07 kB)
journal contribution
posted on 20.11.2018 by J. Erin Allender, Brent N. Reed, Jenna L. Foster, Jeremy D. Mortez, Carrie S. Oliphant, Douglas L. Jennings, Robert J. DiDomenico, James C. Coons
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.

History

Publisher Statement

This is the pre-peer reviewed version of the following article: Allender, J. E., Reed, B. N., Foster, J. L., Moretz, J. D., Oliphant, C. S., Jennings, D. L., DiDomenico, R. J. and Coons, J. C. Pharmacologic Considerations in the Management of Patients Receiving Left Ventricular Percutaneous Mechanical Circulatory Support. Pharmacotherapy. 2017. 37(10): 1272-1283. 10.1002/phar.1995. Article, which has been published in final form at 10.1002/phar.1995.

Citation

Allender, J. E., Reed, B. N., Foster, J. L., Moretz, J. D., Oliphant, C. S., Jennings, D. L., DiDomenico, R. J. and Coons, J. C. Pharmacologic Considerations in the Management of Patients Receiving Left Ventricular Percutaneous Mechanical Circulatory Support. Pharmacotherapy. 2017. 37(10): 1272-1283. 10.1002/phar.1995. Article

Publisher

Wiley

Language

en

issn

0277-0008

Issue date

19/09/2017

Exports