Department of Surgery, University of California, San Diego, CA, USA.
ASAIO J. 2013 May-Jun;59(3):216-20. doi: 10.1097/MAT.0b013e318288a390.
For 15 years, we employed a consistent anticoagulation protocol in 99 consecutive SynCardia Systems total artificial heart (TAH) recipients. Thromboelastography and platelet aggregation studies were used for evaluating and modulating therapy with dipyridamole, pentoxiphylline, aspirin, and heparin. Partial thromboplastin times, international normalized ratios, and platelet counts were also followed. After the second post-implant day in patients who were free of endo-device infection (97 patients), the embolic stroke incidence was 0.08 per patient year. This included 23.6 patient years of device support. There were no spontaneous hemorrhagic strokes. Two patients had endo-device infections and both had strokes. Postimplantation bleeding was seen in 20% of patients. All but two of these were within the first postoperative week. In all, 4% of patients had gastrointestinal bleeding. We did not observe heparin-induced thrombocytopenia in any patient. We conclude that stroke rates on TAH support have been low, and recommend this protocol.
15 年来，我们在 99 例连续的 SynCardia 系统全人工心脏（TAH）受者中采用了一致的抗凝方案。使用血栓弹力图和血小板聚集研究来评估和调整双嘧达莫、己酮可可碱、阿司匹林和肝素的治疗。还监测部分凝血活酶时间、国际标准化比值和血小板计数。在没有内植器械感染的患者（97 例）中，植入后第二天开始，栓塞性中风的发生率为每患者年 0.08 例。这包括 23.6 患者年的器械支持。没有自发性脑出血。两名患者发生内植器械感染，均发生中风。20%的患者出现植入后出血。除了两名患者外，所有患者均在术后第一周内发生。共有 4%的患者发生胃肠道出血。我们没有观察到任何患者发生肝素诱导的血小板减少症。我们得出结论，TAH 支持下的中风发生率较低，并推荐该方案。
