Thoratec HeartMate III, Instructions For Use Manual, Page: 273 / 458

Patient Care and Management 6
HeartMate III Left Ventricular Assist System Instructions for Use 6-9
Anticoagulation
T
O TREAT FOR ANTICOAGULATION
:
1. Prior to leaving the O.R., completely reverse the anticoagulation.
2. Optional: Postimplantation, as early as possible, administer 10% LMW dextran at 25 ml/hr.
This step is optional until the benefit of dextran administration is further delineated.
3. Begin IV heparin after 12–24 hours or when chest tube drainage is less than 50 ml/hr over
a 2–3 hour period:
• Initially titrate to a PTT of 45–50 for 24 hours (1.2–1.4 times control).
• After 24 hours, increase heparin and titrate to PTT 50–60 (1.4–1.7 times control).
• After another 24 hours, increase heparin and titrate to PTT 55–65 (1.5–1.8 times
control).
4. On postoperative day 2–3, initiate aspirin 81–100 mg QD.
5. On postoperative day 3–5, when there is no evidence of bleeding and the chest tubes have
been removed, complete the following steps:
a. Begin warfarin (overlapping with the heparin).
b. Discontinue heparin after obtaining an acceptable, stable INR.
The INR should be maintained in the range of 2.0–3.0.
6. Maintain the patient throughout support on aspirin and warfarin.
Conditions that May Require Possible Modification to Anticoagulation
Consider the need for the following modifications to anticoagulation:
1. Sustained low pump flow states (< 3.0 lpm):
Consider increasing anticoagulation to upper limits of normal.
2. Risk of bleeding:
Consider initiating antiplatelet medications and decreasing heparin/warfarin (INR 1.7–2.3).
Antiplatelet effect should be confirmed with lab studies (for example, TEG).