TY - JOUR
T1 - Heparin dosing in patients with Impella-supported cardiogenic shock
AU - Vandenbriele, Christophe
AU - M'Pembele, René
AU - Dannenberg, Lisa
AU - Metzen, Daniel
AU - Zako, Saif
AU - Helten, Carolin
AU - Mourikis, Philipp
AU - Ignatov, Denis
AU - Huhn, Ragnar
AU - Balthazar, Tim
AU - Adriaenssens, Tom
AU - Vanassche, Thomas
AU - Meyns, Bart
AU - Panoulas, Vasileios
AU - Monteagudo-Vela, Maria
AU - Arachchillage, Deepa
AU - Janssens, Stefan
AU - Scherer, Clemens
AU - Orban, Martin
AU - Petzold, Tobias
AU - Horn, Patrick
AU - Jung, Christian
AU - Zeus, Tobias
AU - Price, Susanna
AU - Westenfeld, Ralf
AU - Kelm, Malte
AU - Polzin, Amin
N1 - Publisher Copyright: © 2023 Elsevier B.V.
PY - 2024/3/15
Y1 - 2024/3/15
N2 - Background: Impella™ is increasingly used in cardiogenic shock. However, thromboembolic and bleeding events are frequent during percutaneous mechanical circulatory support (pMCS). Objective: Therefore, we aimed to explore the optimal anticoagulation regime for pMCS to prevent thromboembolism and bleedings. Methods: This hypothesis-generating multi-center cohort study investigated 170 patients with left-Impella™ support. We (A) compared bleeding/thrombotic events in two centers with therapeutic range (TR-aPTT) activated partial thromboplastin time (60–80s) and (B) compared events of these centers with one center with intermediate range aPTT (40–60s). Results: After matching, there were no differences in patients' characteristics. In centers aiming at TR-aPTT, major bleeding was numerically lower with aPTT <60s within 48 h of left-Impella™ support, versus patients that achieved the aimed aPTT of ≥60s [aPTT ≥60s: 22 (37.3%) vs. aPTT<60s 14 (23.7%); Hazard ratio [HR], 0.62 (95%) CI, 0.28–1.38; p = 0.234]. Major cardiovascular and cerebrovascular adverse events (MACCE) did not differ between groups. In comparison of centers, TR-aPTT strategy showed higher major bleeding rates [TR: 8 (47.1%) vs. intermediate range: 1 (5.9%); HR, 0.06 (95%) CI, 0.01–0.45; p = 0.006]. MACCE were lower in the intermediate range aPTT group as well [TR 12 (70.6%) vs. intermediate range 5 (29.4%) HR, 0.32 (95%) CI, 0.11–0.92; p = 0.034]. Conclusion: This pilot analysis showed that lowering UFH-targets in left-Impella™ supported CS patients seems to be a safe and promising strategy for reducing major bleedings without increasing MACCE. This needs to be validated in larger, randomized clinical trials.
AB - Background: Impella™ is increasingly used in cardiogenic shock. However, thromboembolic and bleeding events are frequent during percutaneous mechanical circulatory support (pMCS). Objective: Therefore, we aimed to explore the optimal anticoagulation regime for pMCS to prevent thromboembolism and bleedings. Methods: This hypothesis-generating multi-center cohort study investigated 170 patients with left-Impella™ support. We (A) compared bleeding/thrombotic events in two centers with therapeutic range (TR-aPTT) activated partial thromboplastin time (60–80s) and (B) compared events of these centers with one center with intermediate range aPTT (40–60s). Results: After matching, there were no differences in patients' characteristics. In centers aiming at TR-aPTT, major bleeding was numerically lower with aPTT <60s within 48 h of left-Impella™ support, versus patients that achieved the aimed aPTT of ≥60s [aPTT ≥60s: 22 (37.3%) vs. aPTT<60s 14 (23.7%); Hazard ratio [HR], 0.62 (95%) CI, 0.28–1.38; p = 0.234]. Major cardiovascular and cerebrovascular adverse events (MACCE) did not differ between groups. In comparison of centers, TR-aPTT strategy showed higher major bleeding rates [TR: 8 (47.1%) vs. intermediate range: 1 (5.9%); HR, 0.06 (95%) CI, 0.01–0.45; p = 0.006]. MACCE were lower in the intermediate range aPTT group as well [TR 12 (70.6%) vs. intermediate range 5 (29.4%) HR, 0.32 (95%) CI, 0.11–0.92; p = 0.034]. Conclusion: This pilot analysis showed that lowering UFH-targets in left-Impella™ supported CS patients seems to be a safe and promising strategy for reducing major bleedings without increasing MACCE. This needs to be validated in larger, randomized clinical trials.
KW - Bleeding
KW - Heparin
KW - Impella
KW - Major adverse cardiac and cerebrovascular events (MACCE)
KW - Percutaneous mechanical circulatory support
UR - http://www.scopus.com/inward/record.url?scp=85182697040&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ijcard.2023.131690
DO - https://doi.org/10.1016/j.ijcard.2023.131690
M3 - Article
C2 - 38160912
SN - 0167-5273
VL - 399
JO - International journal of cardiology
JF - International journal of cardiology
M1 - 131690
ER -