title: Low molecular weight heparin as an alternative to unfractionated heparin in the immediate postoperative period after left ventricular assist device implantation.
abstract: 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.
authors.affiliation: Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. sigrid.sandner@meduniwien.ac.at
authors.forename: Sigrid E
authors.initials: SE
authors.lastname: Sandner
authors.forename: Daniel
authors.initials: D
authors.lastname: Zimpfer
authors.forename: Philipp
authors.initials: P
authors.lastname: Zrunek
authors.forename: Barbara
authors.initials: B
authors.lastname: Steinlechner
authors.forename: Angela
authors.initials: A
authors.lastname: Rajek
authors.forename: Heinrich
authors.initials: H
authors.lastname: Schima
authors.forename: Ernst
authors.initials: E
authors.lastname: Wolner
authors.forename: Georg M
authors.initials: GM
authors.lastname: Wieselthaler
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D017762:Nadroparin; D004176:Dipyridamole; D006493:Heparin; D001241:Aspirin