Faculty Collaboration Database

Mechanical circulatory support: balancing bleeding and clotting in high-risk patients. Hematology Am Soc Hematol Educ Program 2015;2015:61-8

Date

12/08/2015

Pubmed ID

26637702

DOI

10.1182/asheducation-2015.1.61

Scopus ID

2-s2.0-85010991080 (requires institutional sign-in at Scopus site)   37 Citations

Abstract

Mechanical circulatory support (MCS) provides a bridge to heart transplant in children and adults with life-threatening heart failure and sustains patients ineligible for transplant. Extracorporeal membrane oxygenation (ECMO) provides temporary support for patients in cardiac or pulmonary failure through external gas exchange and continuous flow of blood. Because the median time to heart transplant exceeds event-free time on ECMO, pulsatile left ventricular assist devices (LVADs) are used to support infants and children. Continuous flow LVADs are preferred in adolescents and adults due to increased pump durability and improved overall survival. The shear stress created by the mechanical pumps cause changes in the hematologic system; acquired von Willebrand syndrome occurs in almost all patients treated with MCS. Despite the improvements in survival, major bleeding occurs in one-third of patients with a LVAD and ischemic stroke and LVAD thrombosis can affect 12% of adults and 29% of children. An antithrombotic strategy to mitigate LVAD bleeding and thrombotic complications has been tested in a randomized trial in children, but intensity of antithrombotic therapy in adults varies widely. Consensus guidelines for antithrombotic therapy during ECMO were created due to significant differences in management across centers. Because of the high risk for both bleeding and thrombotic complications, experts in hemostasis can significantly impact care of patients requiring mechanical circulatory support and are a necessary part of the management team.

Author List

Baumann Kreuziger L, Massicotte MP

Author

Lisa M. Baumann Kreuziger MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Anticoagulants
Blood Coagulation
Child
Child, Preschool
Clinical Trials as Topic
Extracorporeal Membrane Oxygenation
Heart Failure
Heart Transplantation
Heart-Assist Devices
Hemorrhage
Hemostasis
Humans
Infant
Risk
Treatment Outcome