Antithrombotic therapy for the CardioWest temporary total artificial heart.
The CardioWest temporary total artificial heart serves as a viable bridge to orthotopic heart transplantation in patients who are experiencing end-stage refractory biventricular heart failure. This device is associated with a low, albeit still substantial, risk of thrombosis. Platelet interactions with artificial surfaces are complex and result in continuous activation of contact proteins despite therapeutic anticoagulation. We searched the medical literature (publication dates, January 1962-October 2009) in order to evaluate means of mitigating adverse events that have occurred after implantation of the CardioWest temporary total artificial heart.We conclude that the use of a multitargeted antithrombotic approach, involving anticoagulation (bivalirudin and warfarin) and antiplatelet therapy (dipyridamole and aspirin), can mitigate the procoagulative effects of mechanical circulatory assist devices, particularly those that are associated with the CardioWest temporary total artificial heart. Careful monitoring with use of a variant multisystem approach, involving efficacy tests (thrombelastography and light transmittance aggregometry), safety tests (laboratory analyses), and warfarin genomics, may maximize the therapeutic actions and minimize the bleeding risks that are associated with the multitargeted antithrombotic approach. The development and monitoring of individualized antithrombotic regimens require that informed health professionals appreciate the complexities and grasp the hazards that are associated with these therapies.
Ensor
Christopher R
CR
Department of Pharmacy, Comprehensive Transplant Center, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. censor1@jhmi.edu
Cahoon
William D
WD
Crouch
Michael A
MA
Katlaps
Gundars J
GJ
Hess
Michael L
ML
Cooke
Richard H
RH
Gunnerson
Kyle J
KJ
Kasirajan
Vigneshwar
V
D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects* / Q000235:genetics; D001780:Blood Coagulation Tests; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000097:blood / Q000235:genetics / Q000628:therapy*; D006354:Heart, Artificial / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011474:Prosthesis Design; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000235:genetics / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
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