Anticoagulation of a Percutaneous Left Ventricular Assist Device Using a Low-Dose Heparin Purge Solution Protocol: A Case Series. (August 2020)

• Record Type: Journal Article
• Authors: Newsome, Andrea Sikora; Taylor, Ashley; Garner, Seth
• Is Part Of: Journal of pharmacy practice. Volume 33:Number 4(2020:Aug.)
• Page Start: 471
• Page End: 476
• Publication Date: 2020-08
• Subjects: anticoagulation -- cardiogenic shock -- left ventricular assist device; Pharmacy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1177/0897190018822105
• Languages: English
• ISSNs: 0897-1900

Abstract

Background: Impella CP® is a percutaneous left ventricular assist device that requires a heparin–dextrose purge solution. The manufacturer recommends heparin 50 units/mL, but supratherapeutic anticoagulation has been observed with this concentration. Objective: The purpose of this evaluation was to observe the efficacy and safety of a low-dose heparin-based purge solution (25 units/mL in dextrose 20%). The primary outcome evaluated percentage of activated clotting times (ACTs) below therapeutic range. Secondary objectives included evaluating the incidence of device thrombosis and rate of heparin-induced thrombocytopenia (HIT). Platelet trends were characterized. Methods: A single-site retrospective review was conducted for all adults with the Impella CP from January 2015 to December 2017. Results: A total of 18 patients were included. The percentage of ACT readings within goal of 160 to 200 seconds was 49%, and 38% of readings were subtherapeutic. Per BARC bleeding criteria, 22% (n = 4) patients experienced class IIIa bleeding and 39% (n = 7) experienced class II bleeding. Though 4 (22%) patients were tested for HIT, no patients were positive. Patients showed universal reductions in platelet counts. Conclusions: The use of a low-dose anticoagulation protocol of heparin 25 units/mL in dextrose 20% as needed warrants further evaluation.