Low stroke rate and few thrombo-embolic events after HeartMate II implantation under mild anticoagulation

• Published in: European journal of cardio-thoracic surgery 2012-08, Vol.42 (2), p.319-323
• Main Authors: Menon, Ares K., Götzenich, Andreas, Sassmannshausen, Helena, Haushofer, Marcus, Autschbach, Rüdiger, Spillner, Jan W.
• Format: Article
• Language: English
• Subjects: Anticoagulants - therapeutic use; Aspirin - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Female; Heart; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart-Assist Devices; Heparin - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Neurology; Phenprocoumon - therapeutic use; Pneumology; Stroke - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thromboembolism - prevention & control; Vascular diseases and vascular malformations of the nervous system
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezr312

OBJECTIVES Bleeding and thrombo-embolism are two of the most threatening adverse events associated with the use of continuous flow left ventricular assist devices (LVADs) in the treatment of severe heart failure. We analysed our LVAD patients treated with the HeartMate II (HM II) device by following a low anticoagulation regimen. METHODS Between 2008 and February 2011, we implanted 40 HM II LVADs in our institution. Intention to treat was bridge to transplant in 25, destination therapy in 9, bridge to candidacy in 5 cases and bridge to recovery in 1 case. Heparin was started only after 24 h postoperatively, and Phenprocumon (Phen) was started after removal of all chest drains. International normalized ratio (INR) target in the years 2008-2009 was 2.5, and 2.0-2.5 since 2010. Acetyl salicylic acid (ASA) was prescribed 50-100 mg/day only in patients