title: Multi-Targeted Antithrombotic Therapy for Total Artificial Heart Device Patients.
abstract: To prevent thrombotic or bleeding events in patients receiving a total artificial heart (TAH), agents have been used to avoid adverse events. The purpose of this article is to outline the adoption and results of a multi-targeted antithrombotic clinical procedure guideline (CPG) for TAH patients. Based on literature review of TAH anticoagulation and multiple case series, a CPG was designed to prescribe the use of multiple pharmacological agents. Total blood loss, Thromboelastograph(®) (TEG), and platelet light-transmission aggregometry (LTA) measurements were conducted on 13 TAH patients during the first 2 weeks of support in our institution. Target values and actual medians for postimplant days 1, 3, 7, and 14 were calculated for kaolinheparinase TEG, kaolin TEG, LTA, and estimated blood loss. Protocol guidelines were followed and anticoagulation management reduced bleeding and prevented thrombus formation as well as thromboembolic events in TAH patients postimplantation. The patients in this study were susceptible to a variety of possible complications such as mechanical device issues, thrombotic events, infection, and bleeding. Among them all it was clear that patients were at most risk for bleeding, particularly on postoperative days 1 through 3. However, bleeding was reduced into postoperative days 3 and 7, indicating that acceptable hemostasis was achieved with the anticoagulation protocol. The multidisciplinary, multi-targeted anticoagulation clinical procedure guideline was successful to maintain adequate antithrombotic therapy for TAH patients.
authors.affiliation: Cardiovascular Surgery Division, Perfusion Service Work Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Angeleah
authors.initials: A
authors.lastname: Ramirez
authors.affiliation: Cardiovascular Surgery Division, Perfusion Service Work Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Riley
authors.affiliation: Cardiovascular Surgery Division, Perfusion Service Work Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006354:Heart, Artificial / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010979:Platelet Function Tests; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D013916:Thrombelastography; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: aggregometry; antithrombosis; multi-targeted antithrombotic therapy; thromboelastography; total artificial heart