Antithrombotic management for Impella temporary ventricular assist devices: An analysis of an academic health-system experience.

The use of acute mechanical circulatory support (MCS) has increased over the last decade. For patients with left-ventricular failure, an Impella (Abiomed, Danvers, MA) may be used to improve cardiac output. The purpose of this study is to describe Impella anticoagulation patterns and evaluate the safety and effectiveness of our protocol. This is a retrospective review of all adult patients who required at least 24 h of Impella support and received a heparin-based purge solution. In total, 109 patients were included in the final analysis. The most common indication for Impella device insertion was cardiogenic shock (76%) with the remaining patients receiving a device for a high-risk procedures; typically coronary artery bypass grafting or percutaneous coronary intervention. A total of 9 thrombotic events occurred among 8 (7%) patients and 50 bleeding events occurred among 43 (39%) patients, with the most common classification being BARC 3a (60%). A univariate analysis revealed that patients were more likely to bleed if they were less than 65 years old, had an indication of cardiogenic shock for Impella, inserted the device peripherally, were on dual antiplatelet therapy, or had an intra-aortic balloon pump prior to Impella insertion, the latter of which was confirmed with a multivariate analysis (OR 2.5 [1.072-5.830];  = 0.034). For those monitored by anti-Xa, the presence of two or more values greater than 0.40 IU/mL was a risk factor for bleeding ( = 0.037). Our study identifies risk factors for bleeding in patients receiving temporary MCS with an Impella.