Sandner Sigrid E, Zimpfer Daniel, Zrunek Philipp, Steinlechner Barbara, Rajek Angela, Schima Heinrich, Wolner Ernst, Wieselthaler Georg M
Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.
Artif Organs. 2008 Oct;32(10):819-22. doi: 10.1111/j.1525-1594.2008.00634.x.
We present a regimen for anticoagulation in the immediate postoperative period after left ventricular assist device (LVAD) implantation using low molecular weight heparin (LMWH) as an alternative to unfractionated heparin. Between May and September 2007, eight consecutive patients undergoing LVAD implantation for advanced heart failure received the LMWH nadroparin. Nadroparin was given twice daily to achieve anti-Factor Xa activity target peak levels of 0.4 +/- 0.1 U/mL. The antiplatelet therapy consisted of aspirin (100 mg/day) and dipyridamole (3 x 75 mg/day). One patient underwent heart transplantation, three patients died, and four patients continued to receive device support. The median duration of support was 78 days (range, 46 to 174). No major bleeding was observed; minor bleeding occurred in three patients. In two patients, pump thrombosis was suspected. There were two ischemic and no hemorrhagic strokes. The use of LMWH may provide a new anticoagulation treatment option in the immediate postoperative period after LVAD implantation.
我们提出了一种在左心室辅助装置（LVAD）植入术后即刻使用低分子量肝素（LMWH）替代普通肝素进行抗凝的方案。2007年5月至9月期间，连续8例因晚期心力衰竭接受LVAD植入的患者接受了LMWH那屈肝素治疗。那屈肝素每日给药两次，以使抗Xa因子活性目标峰值水平达到0.4±0.1 U/mL。抗血小板治疗包括阿司匹林（100 mg/天）和双嘧达莫（3×75 mg/天）。1例患者接受了心脏移植，3例患者死亡，4例患者继续接受装置支持。支持的中位持续时间为78天（范围46至174天）。未观察到严重出血；3例患者发生轻微出血。2例患者疑似发生泵血栓形成。发生了2次缺血性卒中，无出血性卒中。LMWH的使用可能为LVAD植入术后即刻提供一种新的抗凝治疗选择。
