Blum Emily C, Martz Carolyn R, Selektor Yelena, Nemeh Hassan, Smith Zachary R, To Long
1 Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA.
2 Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
J Pharm Pract. 2018 Oct;31(5):514-518. doi: 10.1177/0897190017727191. Epub 2017 Aug 23.
Impella devices are percutaneously inserted ventricular assist devices which require a continuous purge solution that contains heparin to prevent pump thrombosis and device failure. We describe 2 patients with heparin-induced thrombocytopenia (HIT) supported with an Impella device utilizing an argatroban-based purge solution. Case 1 involved an 83-year-old female with biventricular failure which resulted in right ventricle Impella support. The purge solution was changed to include argatroban due to concern of device clotting in the setting of HIT. Case 2 involved a 55-year-old male with worsening cardiogenic shock which resulted in left ventricle Impella support. Due to decreased purge flow rates and concerns for clotting, argatroban was added to the purge solution. Both patients' total argatroban regimens were monitored and adjusted by pharmacy, resulting in therapeutic anticoagulation without any major bleeding or thrombotic events. Subsequently, a protocol was designed and implemented. These case reports appear to demonstrate the safe and effective use of argatroban purge solutions for the necessary anticoagulation with an Impella device. Further studies are needed to confirm these results and determine the optimal dosing regimen.
Impella装置是经皮插入的心室辅助装置，需要含有肝素的持续冲洗液以防止泵血栓形成和装置故障。我们描述了2例使用基于阿加曲班的冲洗液并由Impella装置支持的肝素诱导的血小板减少症（HIT）患者。病例1为一名83岁的双心室衰竭女性，接受了右心室Impella支持。由于担心在HIT情况下装置凝血，冲洗液改为包含阿加曲班。病例2为一名55岁的男性，心源性休克恶化，接受了左心室Impella支持。由于冲洗流速降低和对凝血的担忧，在冲洗液中添加了阿加曲班。两名患者的阿加曲班总用药方案均由药房监测和调整，实现了治疗性抗凝，未发生任何重大出血或血栓事件。随后，设计并实施了一项方案。这些病例报告似乎证明了阿加曲班冲洗液在Impella装置必要抗凝中的安全有效使用。需要进一步研究以证实这些结果并确定最佳给药方案。
