Postoperative bridging anticoagulation and left ventricular assist system thrombosis
Research article published in Journal of thrombosis and thrombolysis (2019)
Abstract
Reduced emphasis on early postoperative bridging anticoagulation is one explanation for the increased incidence of HeartMate II (HM II) pump thrombosis. We conducted a single-center analysis of initial postoperative anticoagulation practices and their impact on the incidence of HM II pump thrombosis. Data was collected on 105 patients undergoing primary HM II implant from 2009 to 2014. A parenteral bridge was defined as use of parenteral anticoagulation prior to attainment of an international normalized ratio ≥ 2 on warfarin. A parenteral bridge was further characterized as early if initiated ≤ 3 days of implant and therapeutic if a manufacturer-specified goal partial thromboplastin time (PTT) was achieved during each of the first 3 days of administration. Pump thrombosis was "suspected" based upon suggestive clinical parameters leading to hospital admission with parenteral anticoagulant administration and "confirmed" by direct visualization of thrombus in the device. A majority of patients (70%) were treated with an initial parenteral bridge, which was started within 3 days of device implantation in 68% of cases. Therapeutic PTT levels were achieved in 52% of patients treated with a parenteral bridge. Patients who were bridged had lower Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles (p = 0.039) and longer intensive care unit stay (p = 0.005). Pump thrombosis was suspected in 25% and confirmed in 13% of patients within 6 months of implant. Point estimates of pump thrombosis incidence demonstrated a lower event rate at 6 months in patients who received a therapeutic bridge (15.8%, 95% CI 6.3-29.1% for suspected; 7.9%, 95% CI 2.0-19.3% for confirmed) compared to those who did not receive a therapeutic bridge (29.9%, CI 19.3-41.1% for suspected; 16.4%, 95% CI 8.7-26.3% for confirmed). This trend was not sustained at 12 and 24 months. Cumulative incidence analyses showed no significant difference in the overall incidence of pump thrombosis between patients who did and did not receive a parenteral bridge. In patients undergoing HM II implantation, the use of initial postoperative parenteral bridging anticoagulation is common but frequently sub-therapeutic. Use of a parenteral bridge reaching therapeutic targets may decrease the 6-month but not the overall incidence of pump thrombosis.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This single-center retrospective analysis of 105 HeartMate II left ventricular assist device implants examined whether early parenteral 'bridging' anticoagulation reduced pump thrombosis, finding that a therapeutic bridge was associated with a lower 6-month rate of suspected and confirmed pump thrombosis but that this benefit was not sustained at 12-24 months and overall cumulative incidence did not differ significantly between bridged and non-bridged patients. Its connection to hirudotherapy is only the broad theme of perioperative anticoagulation strategy; it concerns a mechanical cardiac device and systemic anticoagulants, not medicinal leeches or flap salvage. Caveat: this is a small retrospective single-center cohort about LVAD management with no leech-therapy content, so it offers background on anticoagulation decision-making at most and no direct evidence for hirudotherapy.
Citation
Postoperative bridging anticoagulation and left ventricular assist system thrombosis.
Nemer et al. · Journal of thrombosis and thrombolysis, 2019
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