PMID- 31772529
OWN - NLM
STAT- MEDLINE
DCOM- 20200304
LR  - 20220411
IS  - 1540-8183 (Electronic)
IS  - 0896-4327 (Print)
IS  - 0896-4327 (Linking)
VI  - 2019
DP  - 2019
TI  - Survey of Anticoagulation Practices with the Impella Percutaneous Ventricular 
      Assist Device at High-Volume Centers.
PG  - 3791307
LID - 10.1155/2019/3791307 [doi]
LID - 3791307
AB  - OBJECTIVES: To characterize anticoagulation practices with the Impella 
      percutaneous ventricular assist device (pVAD). BACKGROUND: Managing 
      anticoagulation in patients being supported by the Impella pVAD is made 
      challenging by several unique features of the device. These include the release 
      of a dextrose-based purge solution containing unfractionated heparin (UFH), the 
      need to concurrently administer systemic anticoagulation with intravenous UFH, 
      and the lack of an alternative strategy in patients with contraindications to 
      UFH. METHODS: To characterize anticoagulation practices with the Impella pVAD, we 
      conducted a survey of centers in the United States performing a high volume of 
      Impella cases, which we defined as > 1 per month. Centers were contacted via 
      email or phone and individuals who agreed to participate were provided with a 
      link to complete the survey online. The primary measures of interest were 
      variations in practice across centers and variations from the manufacturer's 
      recommendations. RESULTS: Practices varied considerably among respondents (65 of 
      182 centers, or 35.7%) and often diverged from manufacturer recommendations. 
      Approximately half of centers (52.4%) reported using a UFH concentration of 50 
      units/mL in the purge solution, whereas most of the remaining centers (41.3%) 
      reported using lower concentrations. Strategies for the initiation and adjustment 
      of systemic therapy also varied, as did practices for routinely monitoring for 
      hemolysis. Nearly one-fifth of centers (16.7%) had not developed an alternative 
      strategy for the purge solution in patients with contraindications to UFH. Most 
      centers (58.4%) reported using argatroban or bivalirudin in this scenario, a 
      strategy that diverges from the manufacturer's recommendations. CONCLUSIONS: 
      Given these findings, studies to determine a systematic approach to 
      anticoagulation with the Impella device are warranted.
CI  - Copyright (c) 2019 Brent N. Reed et al.
FAU - Reed, Brent N
AU  - Reed BN
AUID- ORCID: 0000-0002-3867-070X
AD  - University of Maryland School of Pharmacy, USA.
FAU - DiDomenico, Robert J
AU  - DiDomenico RJ
AD  - University of Illinois at Chicago, USA.
FAU - Allender, J Erin
AU  - Allender JE
AD  - WakeMed Health & Hospitals, USA.
FAU - Coons, James C
AU  - Coons JC
AUID- ORCID: 0000-0002-7193-3751
AD  - University of Pittsburgh School of Pharmacy and UPMC Presbyterian Hospital, USA.
FAU - Cox, Jenna F
AU  - Cox JF
AD  - Palmetto Health Richland, USA.
FAU - Johnson, Daniel
AU  - Johnson D
AD  - Vanderbilt University Medical Center, USA.
FAU - Oliphant, Carrie S
AU  - Oliphant CS
AD  - Methodist Healthcare-University Hospital, USA.
FAU - Jennings, Douglas L
AU  - Jennings DL
AD  - New York Presbyterian Columbia University Medical Center, USA.
LA  - eng
PT  - Journal Article
DEP - 20190304
PL  - United States
TA  - J Interv Cardiol
JT  - Journal of interventional cardiology
JID - 8907826
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Pipecolic Acids)
RN  - 0 (Recombinant Proteins)
RN  - 0 (Sulfonamides)
RN  - 9005-49-6 (Heparin)
RN  - 94ZLA3W45F (Arginine)
RN  - IY90U61Z3S (argatroban)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/*administration & dosage
MH  - Arginine/analogs & derivatives
MH  - *Heart-Assist Devices
MH  - Heparin/administration & dosage
MH  - Hirudins/administration & dosage
MH  - Humans
MH  - Peptide Fragments/administration & dosage
MH  - Pipecolic Acids/administration & dosage
MH  - Practice Patterns, Physicians'/*statistics & numerical data
MH  - Recombinant Proteins/administration & dosage
MH  - Sulfonamides
MH  - Surveys and Questionnaires
MH  - United States
PMC - PMC6739784
COIS- The authors of this manuscript do not have any relevant personal or financial 
      relationships to disclose.
EDAT- 2019/11/28 06:00
MHDA- 2020/03/05 06:00
PMCR- 2019/03/04
CRDT- 2019/11/28 06:00
PHST- 2018/08/17 00:00 [received]
PHST- 2019/02/03 00:00 [accepted]
PHST- 2019/11/28 06:00 [entrez]
PHST- 2019/11/28 06:00 [pubmed]
PHST- 2020/03/05 06:00 [medline]
PHST- 2019/03/04 00:00 [pmc-release]
AID - 10.1155/2019/3791307 [doi]
PST - epublish
SO  - J Interv Cardiol. 2019 Mar 4;2019:3791307. doi: 10.1155/2019/3791307. eCollection 
      2019.