PMID- 29439593
OWN - NLM
STAT- MEDLINE
DCOM- 20200129
LR  - 20220409
IS  - 1531-1937 (Electronic)
IS  - 0897-1900 (Linking)
VI  - 32
IP  - 4
DP  - 2019 Aug
TI  - Bleeding Risks in Patients on Percutaneous Ventricular Assist Devices Receiving 
      Two Different Dextrose Concentrations of Heparinized Purge Solution: A Case 
      Series.
PG  - 464-469
LID - 10.1177/0897190018757148 [doi]
AB  - BACKGROUND: The Impella manufacturer has changed its recommendation for the 
      diluent of the heparinized purge solution from 20% dextrose (D20) to 5% dextrose 
      (D5). This reduced viscosity may result in increased purge solution infusion 
      rates and unfractionated heparin (UFH) exposure. Increased UFH exposure could 
      potentially cause increased bleeding events and may necessitate reduction in UFH 
      concentration in the purge solution. Our objective was to evaluate 
      anticoagulation for patients on Impella pumps receiving heparinized purge 
      solution with D20 or D5 diluents. METHODS: This retrospective cohort analysis 
      evaluated patients requiring Impella support outside of the cardiac 
      catheterization lab. The primary outcome evaluated the number of patients with at 
      least one supratherapeutic activated partial thromboplastin time (aPTT) while 
      receiving heparinized purge solution alone without systemic UFH. Secondary 
      outcomes included heparin concentration changes made to the purge solution, 
      bleeding, and thrombotic events. RESULTS: Twelve patients received Impella 
      support for an average of 37 hours (range, 10.8-89.6). Four patients received D20 
      and 8 patients received D5 purge solution. Five patients had at least one 
      supratherapeutic aPTT while receiving heparinized purge solution alone without 
      additional systemic UFH. All 5 patients were in the D5 group. Of these 5 
      patients, 3 required purge heparin concentration decreases and 3 had bleeding 
      events. No patients had pump thrombosis. CONCLUSION: D5 purge solution with 
      heparin 50 units/mL may increase the risk of supratherapeutic aPTTs, leading to 
      increased bleeding. Decreasing heparin to 25 units/mL as a standard in purge 
      solution may decrease these risks; however, protection against thrombosis remains 
      unknown.
FAU - Dietrich, Jenna N
AU  - Dietrich JN
AUID- ORCID: 0000-0001-8090-1949
AD  - 1 Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, 
      Iowa City, IA, USA.
FAU - Kazmi, Hasan
AU  - Kazmi H
AUID- ORCID: 0000-0003-0049-1228
AD  - 2 Department of Pharmacy Services, Carilion Roanoke Memorial Hospital, Roanoke, 
      VA, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20180213
PL  - United States
TA  - J Pharm Pract
JT  - Journal of pharmacy practice
JID - 8900945
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - IY9XDZ35W2 (Glucose)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Cohort Studies
MH  - Female
MH  - Glucose/*chemistry
MH  - *Heart-Assist Devices
MH  - Hemorrhage/*chemically induced/epidemiology
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
MH  - Thrombosis/prevention & control
OTO - NOTNLM
OT  - Impella
OT  - anticoagulation
OT  - heparin
OT  - left ventricular assist device
OT  - purge solution
EDAT- 2018/02/15 06:00
MHDA- 2020/01/30 06:00
CRDT- 2018/02/15 06:00
PHST- 2018/02/15 06:00 [pubmed]
PHST- 2020/01/30 06:00 [medline]
PHST- 2018/02/15 06:00 [entrez]
AID - 10.1177/0897190018757148 [doi]
PST - ppublish
SO  - J Pharm Pract. 2019 Aug;32(4):464-469. doi: 10.1177/0897190018757148. Epub 2018 
      Feb 13.