Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, UAE.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
J Thromb Thrombolysis. 2023 Jul;56(1):164-174. doi: 10.1007/s11239-023-02807-9. Epub 2023 Apr 25.
Anticoagulation during Impella® support is a challenge due to its complications and inconsistent practice across the globe. This observational, retrospective chart review included all patients with Impella® support at our advanced cardiac center at a quaternary care hospital in the Middle East gulf region. The study was conducted over six years (2016-2022), a time period during which manufacturer recommendations for purge solution, anticoagulation protocols as well as Impella® place in therapy and utilization were all evolving. We aimed to evaluate the efficacy of different anticoagulation practices and association with complications and outcomes. Forty-one patients underwent Impella® during the study period, including 25 patients with support for more than 12 h, and are the focus of our analysis. Cardiogenic shock (n = 25, 60.9%) was the primary indication for Impella®, followed by facilitating high-risk PCI (n = 15, 36.7%) and left ventricular afterload reduction in patients undergoing veno-arterial extracorporeal membrane oxygenation (n = 1, 2.4%). Our overall Impella® usage evolved over the years from a primary use to facilitate a high-risk PCI to the recent more common use of LV unloading in cardiogenic shock. No patients experienced device malfunction and the incidence of other complications including ischemic stroke and bleeding were comparable to those reported in the literature (12.2% and 24% respectively). The 30-day all-cause mortality of 41 patients was 53.6%. In line with the evolving recommendations and evidence, we observed an underutilization of non-heparin-based purge solutions and inconsistent management of anticoagulation in the setting of both Impella® and VA ECMO which necessitates more education and protocols.
在使用 Impella® 期间进行抗凝治疗是一项挑战，因为其并发症和全球各地的实践不一致。这项观察性、回顾性图表研究包括在海湾地区中东一家四级保健医院的高级心脏中心接受 Impella® 支持的所有患者。该研究在六年期间（2016 年至 2022 年）进行，在此期间，制造商对冲洗液、抗凝方案以及 Impella®在治疗中的应用和用途的建议都在不断演变。我们旨在评估不同抗凝实践的效果及其与并发症和结果的关联。在研究期间，有 41 名患者接受了 Impella®治疗，其中 25 名患者的支持时间超过 12 小时，是我们分析的重点。心源性休克（n=25，60.9%）是使用 Impella®的主要指征，其次是为高危 PCI 提供便利（n=15，36.7%）和在接受静脉-动脉体外膜肺氧合（n=1，2.4%）的患者中减轻左心室后负荷。我们的 Impella®使用在过去几年中发生了演变，从主要用于促进高危 PCI 到最近在心源性休克中更常见地用于减轻左心室负荷。没有患者出现设备故障，其他并发症（包括缺血性中风和出血）的发生率与文献报道的相似（分别为 12.2%和 24%）。41 名患者的 30 天全因死亡率为 53.6%。与不断演变的建议和证据一致，我们观察到在 Impella®和 VA ECMO 的应用中，非肝素冲洗液的使用不足和抗凝管理不一致，这需要更多的教育和方案。
