Ensor Christopher R, Cahoon William D, Crouch Michael A, Katlaps Gundars J, Hess Michael L, Cooke Richard H, Gunnerson Kyle J, Kasirajan Vigneshwar
Department of Pharmacy, Comprehensive Transplant Center, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Tex Heart Inst J. 2010;37(2):149-58.
The CardioWest temporary total artificial heart serves as a viable bridge to orthotopic heart transplantation in patients who are experiencing end-stage refractory biventricular heart failure. This device is associated with a low, albeit still substantial, risk of thrombosis. Platelet interactions with artificial surfaces are complex and result in continuous activation of contact proteins despite therapeutic anticoagulation. We searched the medical literature (publication dates, January 1962-October 2009) in order to evaluate means of mitigating adverse events that have occurred after implantation of the CardioWest temporary total artificial heart.We conclude that the use of a multitargeted antithrombotic approach, involving anticoagulation (bivalirudin and warfarin) and antiplatelet therapy (dipyridamole and aspirin), can mitigate the procoagulative effects of mechanical circulatory assist devices, particularly those that are associated with the CardioWest temporary total artificial heart. Careful monitoring with use of a variant multisystem approach, involving efficacy tests (thrombelastography and light transmittance aggregometry), safety tests (laboratory analyses), and warfarin genomics, may maximize the therapeutic actions and minimize the bleeding risks that are associated with the multitargeted antithrombotic approach. The development and monitoring of individualized antithrombotic regimens require that informed health professionals appreciate the complexities and grasp the hazards that are associated with these therapies.
CardioWest临时全人工心脏可作为终末期难治性双心室心力衰竭患者原位心脏移植的可行桥梁。该装置血栓形成风险较低，尽管仍相当可观。血小板与人工表面的相互作用很复杂，尽管进行了治疗性抗凝，仍会导致接触蛋白持续激活。我们检索了医学文献（发表日期为1962年1月至2009年10月），以评估减轻CardioWest临时全人工心脏植入后发生的不良事件的方法。我们得出结论，采用多靶点抗血栓形成方法，包括抗凝（比伐卢定和华法林）和抗血小板治疗（双嘧达莫和阿司匹林），可以减轻机械循环辅助装置的促凝作用，尤其是与CardioWest临时全人工心脏相关的促凝作用。使用多系统方法进行仔细监测，包括疗效测试（血栓弹力图和透光率聚集测定）、安全性测试（实验室分析）和华法林基因组学，可能会使治疗效果最大化，并将与多靶点抗血栓形成方法相关的出血风险降至最低。制定和监测个体化抗血栓形成方案需要明智的健康专业人员了解这些疗法的复杂性并掌握其风险。
