Whole blood hypercoagulability despite anticoagulation during mechanical cardiac assist

Abstract

We report hypercoagulability despite activated partial thromboplastin time (APTT)-guided heparin treatment during Berlin Heart®-supported circulation in a 38-year-old man with heart failure for 19 days. The patient was anticoagulated using unfractionated heparin, acetylsalicylic acid and dipyridamole. Contact and tissue factor-activated thromboelastometry revealed increased clot firmness, although anticoagulation assessed by APTT was in accordance with the treatment protocol. Strength of polymerized fibrin was also increased. We saw no clinical signs of thrombosis. Thromboelastometry normalized after heart transplantation. Our results suggest that hypercoagulability is due to excess fibrin formation. Monitoring anticoagulation using APTT may, therefore, be misleading during mechanical cardiac assist.

Keywords

anticoagulation cardiac assist device

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References

1 Fries D Innerhofer P Streif W . Coagulation monitoring and management of anticoagulation during cardiac assist device support. Ann Thorac Surg 2003; 76: 1593–1597.

2 McBride L Naunheim K Fiore A Moroney DA Swartz MT . Clinical experience with 111 Thoratec ventricular assist devices. Ann Thorac Surg 1999; 67: 1233–1239.

3 McCrath DJ Cerboni E Frumento RJ Hirsh AL Bennett-Guerrero E . Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction. Anesth Analg 2005; 100: 1576–1583.

4 Quigley RL Fried DW Salenger R Pym J Highbloom RY . Thrombelastographic changes in OPCAB surgical patients. Perfusion 2002; 17: 363–367.

5 McCarthy PM Smedira NO Vargo RL . One hundred patients with the HeartMate left ventricular assist device: evolving concepts and technology. J Thorac Cardiovasc Surg 1998; 115: 904–912.

6 Spanier T Oz M Levin H . Activation of coagulation and fibrinolytic pathways in patients with left ventricular assist devices. J Thorac Cardiovasc Surg 1996; 112: 1090–1097.

7 Rastan AJ Lachmann N Walther T . Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO). Int J Artif Organs 2006; 29: 1121–1131.

8 Coppell JA Thalheimer U Zambruni A . The effects of unfractionated heparin, low molecular weight heparin and danaparoid on the thromboelastogram (TEG): an in vitro comparison of standard and heparinase-modified TEGs with conventional coagulation assays. Blood Coagul Fibrinolysis 2006; 17: 97–104.