PMID- 29324514
OWN - NLM
STAT- MEDLINE
DCOM- 20200210
LR  - 20200210
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 65
IP  - 1
DP  - 2019 Jan
TI  - Anticoagulant Bridge Comparison in Mechanical Circulatory Support Patients.
PG  - 54-58
LID - 10.1097/MAT.0000000000000747 [doi]
AB  - Maintaining mechanical circulatory support (MCS) device patients in a specified 
      therapeutic range for anticoagulation remains challenging. Subtherapeutic 
      international normalized ratios (INRs) occur frequently while on warfarin 
      therapy. An effective anticoagulant bridge strategy may improve the care of these 
      patients. This retrospective review of MCS patients with subtherapeutic INRs 
      compared an intravenous unfractionated heparin (UFH) strategy with a subcutaneous 
      enoxaparin or fondaparinux strategy. Native thromboelastography (n-TEG) was used 
      to evaluate anticoagulant effect with coagulation index (CI) as the primary 
      outcome measure. Enoxaparin 0.5 mg/kg subcutaneously (SC) every 12 hours or 
      fondaparinux 2.5-5 mg SC daily were compared with an initial UFH rate of 5 
      units/kg/hr and titrated to stated n-TEG goal range. The anticoagulant groups 
      UFH, enoxaparin, and fondaparinux were found to be statistically similar with 
      regard to frequency in n-TEG goal range, above range (hypercoagulability), or 
      below range (hypocoagulability). Clinical outcomes were similar among groups with 
      three gastrointestinal bleeds in UFH, one in enoxaparin, and one in fondaparinux 
      groups. Device thrombosis occurred in one UFH patient, while UFH and fondaparinux 
      groups had one ischemic cerebrovascular accident event each. These strategies 
      provided comparable n-TEG results and clinical outcomes when compared with 
      intravenous UFH. Low-dose enoxaparin or fondaparinux may provide an alternative 
      anticoagulant bridging option in MCS patients presenting with subtherapeutic INR.
FAU - Cosgrove, Richard H
AU  - Cosgrove RH
AD  - From the Department of Pharmacy, Banner University Medical Center Tucson, Tucson, 
      Arizona.
FAU - Basken, Robyn L
AU  - Basken RL
AD  - From the Department of Pharmacy, Banner University Medical Center Tucson, Tucson, 
      Arizona.
FAU - Smith, Richard G
AU  - Smith RG
AD  - Artificial Heart Department, Banner University Medical Center Tucson, Tucson, 
      Arizona.
FAU - Hsu, Chiu-Hsieh
AU  - Hsu CH
AD  - Department of Epidemiology and biostatistics, University of Arizona, Tucson, 
      Arizona.
FAU - Kazui, Toshinobu
AU  - Kazui T
AD  - Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 
      Tucson, Arizona.
FAU - Martinez, Brandon K
AU  - Martinez BK
AD  - From the Department of Pharmacy, Banner University Medical Center Tucson, Tucson, 
      Arizona.
FAU - Burt, Richard W
AU  - Burt RW
AD  - Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 
      Tucson, Arizona.
FAU - Crawford, Eric S
AU  - Crawford ES
AD  - Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 
      Tucson, Arizona.
FAU - Lick, Scott D
AU  - Lick SD
AD  - Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 
      Tucson, Arizona.
FAU - Khalpey, Zain
AU  - Khalpey Z
AD  - Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 
      Tucson, Arizona.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - J177FOW5JL (Fondaparinux)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Enoxaparin/therapeutic use
MH  - Female
MH  - Fondaparinux/therapeutic use
MH  - Heart-Assist Devices/*adverse effects
MH  - Humans
MH  - International Normalized Ratio
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Thrombosis/etiology/*prevention & control
EDAT- 2018/01/13 06:00
MHDA- 2020/02/11 06:00
CRDT- 2018/01/12 06:00
PHST- 2018/01/13 06:00 [pubmed]
PHST- 2020/02/11 06:00 [medline]
PHST- 2018/01/12 06:00 [entrez]
AID - 10.1097/MAT.0000000000000747 [doi]
PST - ppublish
SO  - ASAIO J. 2019 Jan;65(1):54-58. doi: 10.1097/MAT.0000000000000747.