Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
J Artif Organs. 2022 Mar;25(1):9-15. doi: 10.1007/s10047-021-01271-7. Epub 2021 May 13.
Impella (Abiomed, Danvers, MA, USA) is a percutaneous trans-catheter left ventricular assist device. Anticoagulant therapy targeting whole activated clotting time (ACT) between 160 and 180 s is recommended to prevent pump thrombosis during support. However, we sometimes experience fatal bleeding despite achieving the target ACT range. Consecutive patients who received Impella support in our institute between March 2018 and October 2020 were included in this retrospective study. The association between the averaged ACT levels during the Impella support and 30-day mortality was investigated. A total of 36 patients (71 years old, 61% males) were included. Most of the patients were managed within the recommended therapeutic range of ACT, and the average ACT level was 162 s. The higher ACT group (> 168 s) had older age, smaller body mass index, and higher serum creatinine compared with the lower ACT group (p < 0.05 for all). A higher ACT level was an independent risk factor of 30-day mortality with an adjusted hazard ratio of 1.085 (95% confidence interval 1.037-1.154) with a cut-off level of 168 s. There were only two thromboembolic events. Patients managed with higher ACT levels had a higher risk of 30-day mortality during Impella support. A low-dose heparin purge solution might be recommended in patients with high-risk for bleeding events.
Impella（Abiomed，Danvers，MA，美国）是一种经皮经导管左心室辅助装置。建议抗凝治疗目标为全激活凝血时间（ACT）在 160-180 s 之间，以预防支持期间泵血栓形成。然而，尽管达到了目标 ACT 范围，我们有时仍会经历致命性出血。本回顾性研究纳入了 2018 年 3 月至 2020 年 10 月期间在我院接受 Impella 支持的连续患者。研究调查了 Impella 支持期间平均 ACT 水平与 30 天死亡率之间的关系。共纳入 36 例患者（71 岁，61%为男性）。大多数患者的 ACT 管理在推荐的治疗范围内，平均 ACT 水平为 162 s。与低 ACT 组相比，高 ACT 组（>168 s）的年龄更大、体重指数更小、血清肌酐水平更高（所有 p<0.05）。较高的 ACT 水平是 30 天死亡率的独立危险因素，调整后的危险比为 1.085（95%置信区间为 1.037-1.154），截断值为 168 s。仅有 2 例发生血栓栓塞事件。在 Impella 支持期间，ACT 水平较高的患者 30 天死亡率风险更高。对于有出血风险事件的高危患者，可能推荐使用低剂量肝素冲洗溶液。
