From the Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas.
Department of Pharmacy, Memorial Hermann - Woodlands, The Woodlands, Texas.
ASAIO J. 2020 Sep/Oct;66(9):e117-e120. doi: 10.1097/MAT.0000000000001126.
The use of percutaneous ventricular assist devices (VADs) in the acute management of cardiogenic shock is becoming increasingly common. The Impella is a percutaneous VAD, which requires a heparin-containing purge solution to prevent thrombosis and maintain proper pump functionality. In this report, we describe two patients with heparin-induced thrombocytopenia (HIT) supported with an Impella using a bivalirudin-containing purge solution. Case 1 involved a 39-year-old man with cardiogenic shock, initially implanted with an intraaortic balloon pump, who developed HIT early in his hospital course. His worsening hemodynamics necessitated the placement of an Impella and later venoarterial extracorporeal membrane oxygenation until he eventually underwent durable left VAD implantation. Case 2 involved a 69-year-old man who had an Impella implanted for worsening cardiogenic shock. HIT was suspected shortly after device insertion, necessitating switching his anticoagulation to bivalirudin. He was successfully bridged directly to heart transplantation. Both patients' courses resulted in therapeutic anticoagulation without major bleeding or thrombotic events. These cases demonstrate the safe and effective use of bivalirudin-containing purge solutions for patients with confirmed HIT requiring temporary mechanical circulatory support with Impella.
经皮心室辅助装置（VAD）在治疗心源性休克中的应用越来越普遍。Impella 是一种经皮 VAD，需要使用含有肝素的冲洗液来预防血栓形成并保持适当的泵功能。在本报告中，我们描述了两例使用含有比伐卢定的冲洗液支持的 Impella 治疗肝素诱导的血小板减少症（HIT）的患者。病例 1 涉及一名 39 岁的男性，因心源性休克，最初植入了主动脉内球囊泵，在住院期间早期发生了 HIT。他的血流动力学恶化需要植入 Impella，后来还需要进行静脉动脉体外膜肺氧合，直到最终植入耐用型左心室辅助装置。病例 2 涉及一名 69 岁的男性，因心源性休克恶化而植入 Impella。在装置插入后不久怀疑发生了 HIT，需要将抗凝剂转换为比伐卢定。他成功地直接过渡到心脏移植。这两例患者的治疗结果均为抗凝治疗有效，无大出血或血栓事件。这些病例表明，对于确诊需要使用 Impella 进行临时机械循环支持的 HIT 患者，使用含有比伐卢定的冲洗液是安全有效的。
