PMID- 38529950
OWN - NLM
STAT- Publisher
LR  - 20240326
IS  - 2048-8734 (Electronic)
IS  - 2048-8726 (Linking)
DP  - 2024 Mar 26
TI  - European practices on antithrombotic management during percutaneous mechanical 
      circulatory support in adults: A survey of the Association for Acute 
      CardioVascular Care (ACVC) of the ESC and the European branch of the 
      Extracorporeal Life Support Organization (EuroELSO).
LID - zuae040 [pii]
LID - 10.1093/ehjacc/zuae040 [doi]
AB  - BACKGROUND: Bleeding and thrombotic complications compromise outcomes in patients 
      undergoing percutaneous mechanical circulatory support (pMCS) with veno-arterial 
      extracorporeal membrane oxygenation (V-A ECMO) and/or microaxial flow pumps like 
      the Impella. Antithrombotic practices are an important determinant of the 
      coagulopathic risk, but standardization in the antithrombotic management during 
      pMCS is lacking. This survey outlines European practices in antithrombotic 
      management in adults on pMCS, making an initial effort to standardize practices, 
      inform future trials, and enhance outcomes. METHODS: This online cross-sectional 
      survey was distributed through digital newsletters and social media platforms by 
      the Association of Acute Cardiovascular Care and the European branch of the 
      Extracorporeal Life Support Organization. The survey was available from April 
      17th to May 23rd, 2023. The target population were European clinicians involved 
      in care for adults on pMCS. RESULTS: We included 105 responses from 26 European 
      countries. Notably, 72.4% of the respondents adhered to locally established 
      anticoagulation protocols, with unfractionated heparin (UFH) being the 
      predominant anticoagulant (Impella: 97.0% and V-A ECMO: 96.1%). A minority, 
      10.8% and 14.5%, respectively, utilized anti-factor-Xa assay with activated 
      partial thromboplastin time in parallel for UFH monitoring during Impella and 
      V-A ECMO support. Anticoagulant targets varied across institutions. Following 
      acute coronary syndrome without percutaneous coronary intervention (PCI), 54.0% 
      and 42.7% administered dual antiplatelet therapy during Impella and V-A ECMO 
      support, increasing to 93.7% and 84.0% after PCI. CONCLUSIONS: Substantial 
      heterogeneity in antithrombotic practices emerged from participants' responses, 
      potentially contributing to variable device-associated bleeding and thrombotic 
      complications.
CI  - (c) The Author(s) 2024. Published by Oxford University Press on behalf of the 
      European Society of Cardiology. All rights reserved. For commercial re-use, 
      please contact reprints@oup.com for reprints and translation rights for reprints. 
      All other permissions can be obtained through our RightsLink service via the 
      Permissions link on the article page on our site-for further information please 
      contact journals.permissions@oup.com.
FAU - Van Edom, Charlotte J
AU  - Van Edom CJ
AUID- ORCID: 0000-0003-2830-624X
AD  - Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, 
      Belgium.
AD  - Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
FAU - Swol, Justyna
AU  - Swol J
AUID- ORCID: 0000-0002-2903-092X
AD  - Department of Respiratory Medicine, Paracelsus Medical University Nuremberg, 
      Germany.
FAU - Castelein, Thomas
AU  - Castelein T
AD  - Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.
FAU - Gramegna, Mario
AU  - Gramegna M
AUID- ORCID: 0000-0002-9709-6082
AD  - Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, 
      Italy.
FAU - Huber, Kurt
AU  - Huber K
AUID- ORCID: 0000-0003-1695-3378
AD  - 3rd Department of Medicine, Cardiology and Intensive Care Medicine, 
      Wilhelminenhospital and Sigmund Freud University, Medical Faculty, Vienna, 
      Austria.
FAU - Leonardi, Sergio
AU  - Leonardi S
AUID- ORCID: 0000-0002-4800-6132
AD  - Department of Medical Sciences and Infective Disease, University of Pavia and 
      Fondazione, IRCCS Policlinico San Matteo, Pavia, Italy.
FAU - Mueller, Thomas
AU  - Mueller T
AD  - Department of Internal Medicine II, University Hospital Regensburg, Regensburg, 
      Germany.
FAU - Pappalardo, Federico
AU  - Pappalardo F
AUID- ORCID: 0000-0001-9129-833X
AD  - Department of Anesthesia & Intensive Care, Azienda Ospedaliera SS. Antonio e 
      Biagio e Cesare Arrigo, Alessandria, Italy.
FAU - Price, Susanna
AU  - Price S
AUID- ORCID: 0000-0002-6425-3360
AD  - Department of Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St 
      Thomas' NHS Foundation Trust, London, United Kingdom.
AD  - National Heart and Lung Institute, Imperial College, London, United Kingdom.
FAU - Schaubroeck, Hannah
AU  - Schaubroeck H
AUID- ORCID: 0000-0002-5219-4834
AD  - Department of Intensive Care Medicine, Ghent University Hospital, Ghent 
      University, Ghent, Belgium.
FAU - Schrage, Benedikt
AU  - Schrage B
AUID- ORCID: 0000-0001-9041-3922
AD  - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, 
      Germany.
FAU - Tavazzi, Guido
AU  - Tavazzi G
AUID- ORCID: 0000-0002-9560-5138
AD  - Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University 
      of Pavia, Pavia, Italy.
AD  - Intensive Care Unit, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy.
FAU - Vercaemst, Leen
AU  - Vercaemst L
AD  - Department of Perfusion, University Hospital Gasthuisberg, Leuven, Belgium.
FAU - Vranckx, Pascal
AU  - Vranckx P
AUID- ORCID: 0000-0002-1526-0652
AD  - Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa 
      Ziekenhuis, and the Faculty of Medicine and Life Sciences, Hasselt University, 
      Hasselt.
FAU - Vandenbriele, Christophe
AU  - Vandenbriele C
AUID- ORCID: 0000-0001-5151-6400
AD  - Department of Critical Care, Royal Brompton & Harefield Hospitals, Guy's and St 
      Thomas' NHS Foundation Trust, London, United Kingdom.
LA  - eng
PT  - Journal Article
DEP - 20240326
PL  - England
TA  - Eur Heart J Acute Cardiovasc Care
JT  - European heart journal. Acute cardiovascular care
JID - 101591369
SB  - IM
OTO - NOTNLM
OT  - ECMO
OT  - anticoagulation
OT  - antiplatelets
OT  - bleeding
OT  - mechanical circulatory support
EDAT- 2024/03/26 12:46
MHDA- 2024/03/26 12:46
CRDT- 2024/03/26 08:54
PHST- 2024/01/18 00:00 [received]
PHST- 2024/03/20 00:00 [revised]
PHST- 2024/03/22 00:00 [accepted]
PHST- 2024/03/26 12:46 [medline]
PHST- 2024/03/26 12:46 [pubmed]
PHST- 2024/03/26 08:54 [entrez]
AID - 7634878 [pii]
AID - 10.1093/ehjacc/zuae040 [doi]
PST - aheadofprint
SO  - Eur Heart J Acute Cardiovasc Care. 2024 Mar 26:zuae040. doi: 
      10.1093/ehjacc/zuae040.