Coagulation monitoring and management of anticoagulation during cardiac assist device support Dietmar Fries, MD, Petra Innerhofer, MD, Werner Streif,

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Presentation transcript:

Coagulation monitoring and management of anticoagulation during cardiac assist device support Dietmar Fries, MD, Petra Innerhofer, MD, Werner Streif, MD, Wolfgang Schobersberger, MD, Josef Margreiter, MD, Herwig Antretter, MD, Christoph Hörmann, MD The Annals of Thoracic Surgery Volume 76, Issue 5, Pages 1593-1597 (November 2003) DOI: 10.1016/S0003-4975(03)01034-8

Fig 1 Thrombelastographic monitoring system (ROTEG) analysis: maximum clot firmness (squares; in mm) and alpha angle (diamonds) from 23 days after biventricular assist device system implantation until 1 week after heart transplantation. After introducing therapy with clopidogrel, maximum clot firmness and alpha angle decreased to normal values. (TX = treatment.) The Annals of Thoracic Surgery 2003 76, 1593-1597DOI: (10.1016/S0003-4975(03)01034-8)

Fig 2 Results of platelet function analyzer examinations after biventricular assist device system implantation as well as after heart transplantation. Collagen/epinephrine coagulation time (CT) and adenosin diphosphate-CT were in the normal range despite aspirin therapy. Clotting times increased after introducing therapy with clopidogrel. Values normalized after heart transplantation was performed and clopidogrel therapy was terminated. (alp = alpha angle; CFT = clot formation time; EXTEG = thrombelastastographic analysis, activated with tissue thromboplastin; MCF = maximum clot firmness; roTEG = thrombelastic monitoring system.) The Annals of Thoracic Surgery 2003 76, 1593-1597DOI: (10.1016/S0003-4975(03)01034-8)

Fig 3 Demonstration of coagulation management over the whole period of treatment. (EPI-CT = collagen/epinephrine coagulation time [diamonds]; ADP-CT = coagulation time [squares].) (TX = treatment.) The Annals of Thoracic Surgery 2003 76, 1593-1597DOI: (10.1016/S0003-4975(03)01034-8)

Fig 4 Thrombelastographic monitoring system (ROTEG) tracing 23 days after biventricular assist device (BIVAD) implantation and 1 week after heart transplantation: detection of a hypercoagulable coagulation status by early onset and high amplitude on day 23 after BIVAD implantation; decrease in maximum clot firmness; and alpha angle back to normal values after heart transplantation. (ECMO = extracorporeal membrane oxygenation; LMW = low molecular weight; PFA = platelet function analyzer; TX = treatment.) The Annals of Thoracic Surgery 2003 76, 1593-1597DOI: (10.1016/S0003-4975(03)01034-8)