Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
J Heart Lung Transplant. 2014 Jan;33(1):88-93. doi: 10.1016/j.healun.2013.10.009. Epub 2013 Oct 11.
Anti-coagulation is required in patients with left ventricular assist devices (LVADs). We evaluated the feasibility of low-molecular-weight heparin (LMWH) for initiation of anti-coagulation and transitioning to oral anti-coagulation after LVAD implantation.
This single-center study included 78 consecutive patients who underwent either Thoratec HeartMate II LVAD (n = 27) or HeartWare ventricular assist device (HVAD, n = 51) implantation. The LMWHs enoxaparin (n = 50) and dalteparin (n = 28) were used. LMWH was started within 24 hours post-operatively in 79.5% of patients. No anti-coagulation was given before starting LMWH therapy. LMWH activity was monitored by determination of anti-factor Xa levels in plasma.
The majority of patients (80.7%) had peak anti-Xa activity within the defined range of efficacy of 0.2 to 0.4 IU/ml by the second day of treatment. Mean effective peak anti-Xa activity was 0.28 ± 0.06 IU/ml. Mean duration of anti-coagulation with LMWH was 25.8 ± 18 days. Ischemic strokes were observed in 3 patients (3.8%), with a total of 4 events. Three events occurred while on LMWH, and 1 event occurred during follow-up on oral anti-coagulation. There was 1 fatal stroke. No pump thrombus was observed. Major bleeding was observed in 5 patients (6.4%), with a total of 6 events. Gastrointestinal bleeding was the most common complication (n = 3). There were no fatal bleeding events.
LMWH in the setting of LVAD shows rapid and constant biologic efficacy. Anti-coagulation with LMWH appears feasible after LVAD implantation. These findings support further evaluation of LMWH as an alternative to unfractionated heparin in this patient cohort.
左心室辅助装置（LVAD）患者需要抗凝。我们评估了低分子肝素（LMWH）用于启动抗凝并在 LVAD 植入后转为口服抗凝的可行性。
这项单中心研究纳入了 78 例连续接受 Thoratec HeartMate II LVAD（n=27）或 HeartWare 心室辅助装置（HVAD，n=51）植入的患者。使用 LMWH 依诺肝素（n=50）和达肝素（n=28）。79.5%的患者在术后 24 小时内开始使用 LMWH。在开始 LMWH 治疗之前，未给予任何抗凝治疗。通过测定血浆中抗因子 Xa 水平来监测 LMWH 的活性。
大多数患者（80.7%）在治疗的第二天达到了 0.2 至 0.4IU/ml 的有效范围峰值抗 Xa 活性。平均有效峰值抗 Xa 活性为 0.28±0.06IU/ml。LMWH 抗凝的平均持续时间为 25.8±18 天。3 例患者（3.8%）发生缺血性卒中，共 4 例。3 例事件发生在使用 LMWH 期间，1 例事件发生在口服抗凝期间的随访期间。有 1 例致命性卒中。未观察到泵血栓。5 例患者（6.4%）发生主要出血，共 6 例。胃肠道出血是最常见的并发症（n=3）。无致命性出血事件。
LVAD 中 LMWH 表现出快速且持续的生物学疗效。LVAD 植入后使用 LMWH 进行抗凝似乎是可行的。这些发现支持进一步评估 LMWH 作为该患者人群中肝素的替代药物。
