Low molecular weight heparin as an alternative to unfractionated heparin in the immediate postoperative period after left ventricular assist device implantation.
We present a regimen for anticoagulation in the immediate postoperative period after left ventricular assist device (LVAD) implantation using low molecular weight heparin (LMWH) as an alternative to unfractionated heparin. Between May and September 2007, eight consecutive patients undergoing LVAD implantation for advanced heart failure received the LMWH nadroparin. Nadroparin was given twice daily to achieve anti-Factor Xa activity target peak levels of 0.4 +/- 0.1 U/mL. The antiplatelet therapy consisted of aspirin (100 mg/day) and dipyridamole (3 x 75 mg/day). One patient underwent heart transplantation, three patients died, and four patients continued to receive device support. The median duration of support was 78 days (range, 46 to 174). No major bleeding was observed; minor bleeding occurred in three patients. In two patients, pump thrombosis was suspected. There were two ischemic and no hemorrhagic strokes. The use of LMWH may provide a new anticoagulation treatment option in the immediate postoperative period after LVAD implantation.
Sandner
Sigrid E
SE
Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. sigrid.sandner@meduniwien.ac.at
Zimpfer
Daniel
D
Zrunek
Philipp
P
Steinlechner
Barbara
B
Rajek
Angela
A
Schima
Heinrich
H
Wolner
Ernst
E
Wieselthaler
Georg M
GM
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage; D004176:Dipyridamole / Q000008:administration & dosage; D006333:Heart Failure / Q000601:surgery / Q000628:therapy; D006353:Heart-Assist Devices; D006493:Heparin / Q000737:chemistry; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D011184:Postoperative Period; D019736:Prostheses and Implants / Q000009:adverse effects; D013927:Thrombosis / Q000517:prevention & control
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D017762:Nadroparin; D004176:Dipyridamole; D006493:Heparin; D001241:Aspirin