PMID- 34250827
OWN - NLM
STAT- MEDLINE
DCOM- 20210921
LR  - 20210921
IS  - 1724-6040 (Electronic)
IS  - 0391-3988 (Linking)
VI  - 44
IP  - 10
DP  - 2021 Oct
TI  - Outcomes of systemic anticoagulation with bivalirudin for Impella 5.0.
PG  - 681-686
LID - 10.1177/03913988211032238 [doi]
AB  - Temporary mechanical circulatory support (tMCS) devices are used for the 
      management of cardiogenic shock. The Impella 5.0 (Abiomed; Danvers, MA) (IMP5) is 
      a commonly used, surgically implanted, tMCS device that requires systemic 
      anticoagulation and purge solution to avoid pump failure. To avoid 
      heparin-induced thrombocytopenia (HIT) from unfractionated heparin (UFH) use, our 
      program has explored the utility of bivalirudin (BIV) for systemic 
      anticoagulation in IMP5. This single center, retrospective study included 
      patients supported on IMP5 with BIV based AC. The efficacy and safety end points 
      were recovery, bridge to left ventricular assist device (LVAD), cardiac 
      transplant (HTX), or death as well as clinically significant bleeding, incidence 
      of Tissue Plasminogen Activator (tPA) use for suspected pump thrombosis, stroke, 
      and device failure. There were 31 patients included, and 26 (84%) received BIV 
      purge solutions. The median duration of IMP5 was 6 (IQR 4-10) days. Most patients 
      were bridged to LVAD (39%, 12); 16% (5) were bridged to HTX, 16% (5) recovered, 
      and 29% (9) died. One patient (3%) suffered from ischemic stroke and 12% (4) 
      patients developed clinically significant bleeding. tPA was administered to 8 
      (26%) patients. Logistic regression analysis demonstrated that duration of IMP5 
      was a significant predictor of tPA use (OR 1.28; 95% Confidence Interval 
      1.04-1.56). There were no cases of pump failure. Our experience highlights the 
      feasibility of utilizing BIV for routine AC use in IMP5.
FAU - Fabrizio, Carly
AU  - Fabrizio C
AUID- ORCID: 0000-0002-6822-7530
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
FAU - Levito, Marissa N
AU  - Levito MN
AD  - Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, 
      USA.
FAU - Rivosecchi, Ryan
AU  - Rivosecchi R
AD  - Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, 
      USA.
FAU - Bashline, Michael
AU  - Bashline M
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
FAU - Slocum, Brittany
AU  - Slocum B
AD  - Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, 
      USA.
FAU - Kilic, Arman
AU  - Kilic A
AD  - Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
FAU - Toma, Catalin
AU  - Toma C
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
FAU - Murray, Holt
AU  - Murray H
AD  - Department of Critical Care Medicine, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
FAU - Ramanan, Raj
AU  - Ramanan R
AUID- ORCID: 0000-0002-1970-2964
AD  - Department of Critical Care Medicine, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
FAU - Fowler, Jeffrey
AU  - Fowler J
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
FAU - Hickey, Gavin W
AU  - Hickey GW
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
FAU - Horn, Edward T
AU  - Horn ET
AD  - Heart and Vascular Institute, University of Pittsburgh Medical Center, 
      Pittsburgh, PA, USA.
AD  - Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, 
      USA.
LA  - eng
PT  - Journal Article
DEP - 20210712
PL  - United States
TA  - Int J Artif Organs
JT  - The International journal of artificial organs
JID - 7802649
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - *Heart-Assist Devices/adverse effects
MH  - Heparin/adverse effects
MH  - Hirudins
MH  - Humans
MH  - Peptide Fragments
MH  - Recombinant Proteins
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/therapy
MH  - *Tissue Plasminogen Activator/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Cardiac assist and artificial heart
OT  - VAD axial flow
OT  - antithrombotic therapy
OT  - cardiac surgery
OT  - cardiothoracic surgery
EDAT- 2021/07/13 06:00
MHDA- 2021/09/22 06:00
CRDT- 2021/07/12 08:42
PHST- 2021/07/13 06:00 [pubmed]
PHST- 2021/09/22 06:00 [medline]
PHST- 2021/07/12 08:42 [entrez]
AID - 10.1177/03913988211032238 [doi]
PST - ppublish
SO  - Int J Artif Organs. 2021 Oct;44(10):681-686. doi: 10.1177/03913988211032238. Epub 
      2021 Jul 12.