DOI: https://doi.org/10.22141/2224-0586.2.97.2019.161646

Analysis of hemorrhagic and thromboembolic complications in patients with implanted left ventricular assist devices

O.P. Mazurenko, P. Nadzaykevich, O.A. Loskutov, L. Zgrezheblovskaya

Abstract


The work deals with the study of hemorrhagic and thromboembolic complications in the early postoperative period in patients with implanted left ventricular assist devices (LVAD). The study included 10 males aged 55.0 ± 13.5 years, with body mass index of 30.8 ± 8.3 kg/m2, left ventricular ejection fraction ranging from 9 to 28 %, who were implanted with LVAD under artificial blood circulation from 11.03.2016 to 22.11.2017 in the Silesian Center for Heart Disease (Poland). In the early postoperative period, patients received daily anticoagulant targeted therapy: heparin (6–11 U/kg/h), aspirin (75–150 mg), сlopidogrel (75–150 mg), warfarin (1.5–7 mg), nadroparin calcium (0.3–0.6 ml twice a day), fondaparinux sodium (2.5–5 mg twice a day). Two patients received heparin monotherapy, one patient — warfarin monotherapy for 14 days. Other patients during the same period received combined heparin therapy in the first three days with a subsequent transition to warfarin, aspirin, clopidogrel, fraxiparin, or thrombin blocker. The mechanical assistance of the left ventricle was carried out essentially by two different implantable systems performing one function of the left ventricular support: POLVAD — program-controlled pneumatic membrane mechanical blood circulation (2 patients), and LVAD — program-controlled electro-centrifugal circulation (8 persons). The duration of support by POLVAD system was from 102 to 156 days, by LVAD — from 20 to 78 days. A comparison of the analyzed results led to the conclusion that anticoagulant monotherapy with heparin or warfarin leads to an increase in the percentage of complications and mortality compared to the alternative combination anticoagulant targeted therapy: heparin (6–11 U/kg/h), aspirin (75–150 mg), clopidogrel (75–150 mg), warfarin (1.5–7 mg), nadroparin calcium (0.3–0.6 ml twice a day), fondaparinux sodium (2.5–5 mg twice a day), where survival rates were significantly higher, by 60 %

Keywords


left ventricular assist device; anticoagulant targeted therapy; hemorrhagic and thromboembolic complications

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