title: Results with an anticoagulation protocol in 99 SynCardia total artificial heart recipients.
abstract: For 15 years, we employed a consistent anticoagulation protocol in 99 consecutive SynCardia Systems total artificial heart (TAH) recipients. Thromboelastography and platelet aggregation studies were used for evaluating and modulating therapy with dipyridamole, pentoxiphylline, aspirin, and heparin. Partial thromboplastin times, international normalized ratios, and platelet counts were also followed. After the second post-implant day in patients who were free of endo-device infection (97 patients), the embolic stroke incidence was 0.08 per patient year. This included 23.6 patient years of device support. There were no spontaneous hemorrhagic strokes. Two patients had endo-device infections and both had strokes. Postimplantation bleeding was seen in 20% of patients. All but two of these were within the first postoperative week. In all, 4% of patients had gastrointestinal bleeding. We did not observe heparin-induced thrombocytopenia in any patient. We conclude that stroke rates on TAH support have been low, and recommend this protocol.
authors: Department of Surgery, University of California, San Diego, CA, USA. jackcope3@gmail.com
authors: Jack
authors: J
authors: Copeland
authors: Hannah
authors: H
authors: Copeland
authors: Paul
authors: P
authors: Nolan
authors: Monica
authors: M
authors: Gustafson
authors: Marvin
authors: M
authors: Slepian
authors: Richard
authors: R
authors: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D002985:Clinical Protocols; D004176:Dipyridamole / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010431:Pentoxifylline / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D020521:Stroke / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D004176:Dipyridamole; D006493:Heparin; D001241:Aspirin; D010431:Pentoxifylline