Berlin Heart EXCOR Pediatric VAD, Руководство пользователя

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Chapter 12 Anticoagulation therapy
12 Anticoagulation therapy
12.1 Before Implantation of the EXCOR
12.1.1 General considerations
Patients with an EXCOR system must be maintained on anticoagulation therapy.
Anti-Xa levels should be specific to the drug being used, either unfractionated heparin
or enoxaparin.
The TEG
® may be useful in managing unfractionated heparin and antiplatelet therapy.
Please contact Berlin Heart, Clinical Affairs for further information.
12.1.2 Pre implantation
The following laboratory tests should be considered prior to implantation.
• Platelet Function Studies, INR, PTT, fibrinogen, antithrombin III, and platelet
count to establish a baseline. Assessment for thrombophilia by measuring
Protein C, S, Factor V Leiden, Prothrombin 20210 defect, as well as Heparin
Induced Thrombocytopenia (HIT) is recommended.
12.2 During Implantation - Cardiopulmonary Bypass
12.2.1 Cardiopulmonary Bypass (CPB)
Use unfractionated heparin as per institutional protocol for cardiopulmonary bypass.
12.2.2 Post CPB
Completely reverse heparin with protamine sulphate as per institutional protocol.
The goal post-CPB is to achieve normal (institution specific) coagulation parameters
(INR, PTT, fibrinogen, platelet count).
In the early post-operative period, the possibility of surgical bleeding, GI bleeding,
internal bleeding in the retro-peritoneum or other bleeding diathesis is possible and
must be monitored.
If the patient is bleeding despite normal coagulation parameters consider:
• Von Willebrand's
• Surgical bleeding
12.3 Postoperative anticoagulation therapy
12.3.1 General Considerations
Primary tests used to evaluate anticoagulation in the patient include antifactor Xa
levels and/or PTT.
12.3.2 Starting anticoagulation therapy
During the first 24 hours following implantation, no anticoagulants should be
administered.
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