SynCardia TAH-t Instructions for Use
SynCardia Systems, Inc.
Page 27
Post-operative period (immediate)
Start Dipyridamole at 100 mg -250 mg PO or NG every 6 hours. The dose is adjusted to
balance platelet aggregation factors: keep collagen factor positive; keep ADP, epinephrine,
arachnadonic acid factors negative. If all factors are positive, the dose of dipyridamole should
be maximized. If only one factor other than collagen is positive, dipyridamole or ASA is
increased until only collagen is positive. Platelet aggregation studies are checked twice per
week.
Start ASA when platelet aggregation shows any factor other than collagen is positive, usually
within 24 hours post-operative. The ASA dose is started between 81-650 mg PO per day. If
all platelet aggregation factors are positive and the dipyridamole is already started, 325 mg of
ASA is used per day to start. If only one factor, other than collagen, is positive, ASA is
started at 81 mg per day. The dipyridamole is adjusted according to the results of Platelet
Factor 4 and Beta Thromboglobulin. If these tests are elevated, the platelets are very active
and the dipyridamole needs to be increased. ASA is adjusted with the platelet aggregation
and bleeding time studies. The bleeding time is kept between 10 - 20 min if possible.
If the collagen is negative, too much dipyridamole or ASA is being given; daily dosages of
one or both are decreased to prevent bleeding.
Pentoxifylline 400 mg is started PO every 8 hours in the early post-operative period (2-3
days). Pentoxifylline may be increased if fibrinogen increased above normal.
Post-operative (chest tubes pulled)
Start IV Heparin at 25,000 units in 250 cc of D5W at 500-1000 units per hour, when chest
tubes are discontinued. IV Heparin is continued to maintain PTT at 50-55 sec for 2 weeks,
then converted to Coumadin to keep INR 2.5-3.5 or PT 18-22 sec, then IV Heparin is stopped.
Exit Site Management
Take care to keep driveline exit sites clean and dry. Infections should be treated according to
hospital protocol.
