Newsome Andrea Sikora, Taylor Ashley, Garner Seth
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA.
Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA.
J Pharm Pract. 2020 Aug;33(4):471-476. doi: 10.1177/0897190018822105. Epub 2019 Jan 6.
Impella CP® is a percutaneous left ventricular assist device that requires a heparin-dextrose purge solution. The manufacturer recommends heparin 50 units/mL, but supratherapeutic anticoagulation has been observed with this concentration.
The purpose of this evaluation was to observe the efficacy and safety of a low-dose heparin-based purge solution (25 units/mL in dextrose 20%). The primary outcome evaluated percentage of activated clotting times (ACTs) below therapeutic range. Secondary objectives included evaluating the incidence of device thrombosis and rate of heparin-induced thrombocytopenia (HIT). Platelet trends were characterized.
A single-site retrospective review was conducted for all adults with the Impella CP from January 2015 to December 2017.
A total of 18 patients were included. The percentage of ACT readings within goal of 160 to 200 seconds was 49%, and 38% of readings were subtherapeutic. Per BARC bleeding criteria, 22% (n = 4) patients experienced class IIIa bleeding and 39% (n = 7) experienced class II bleeding. Though 4 (22%) patients were tested for HIT, no patients were positive. Patients showed universal reductions in platelet counts.
The use of a low-dose anticoagulation protocol of heparin 25 units/mL in dextrose 20% as needed warrants further evaluation.
Impella CP®是一种经皮左心室辅助装置，需要使用肝素 - 葡萄糖冲洗液。制造商推荐肝素浓度为50单位/毫升，但使用该浓度时已观察到抗凝作用超过治疗范围。
本评估的目的是观察低剂量肝素冲洗液（20%葡萄糖中含25单位/毫升）的疗效和安全性。主要结局评估活化凝血时间（ACT）低于治疗范围的百分比。次要目标包括评估装置血栓形成的发生率和肝素诱导的血小板减少症（HIT）的发生率。对血小板变化趋势进行了特征描述。
对2015年1月至2017年12月期间所有使用Impella CP的成年患者进行了单中心回顾性研究。
共纳入18例患者。ACT读数在160至200秒目标范围内的百分比为49%，38%的读数低于治疗范围。根据BARC出血标准，22%（n = 4）的患者发生IIIa级出血，39%（n = 7）的患者发生II级出血。虽然4例（22%）患者接受了HIT检测，但无一例呈阳性。患者的血小板计数普遍下降。
按需使用20%葡萄糖中含25单位/毫升肝素的低剂量抗凝方案的效果值得进一步评估。
