Low Molecular Weight Heparin as an Alternative to Unfractionated Heparin in the Immediate Postoperative Period After Left Ventricular Assist Device Implantation

Sigrid Sandner; Daniel Zimpfer; Philipp Zrunek; Barbara Steinlechner; Angela Rajek; Heinrich Schima; Ernst Wolner; Georg Wieselthaler

doi:10.1111/j.1525-1594.2008.00634.x

October 1, 2008Artificial Organs

Low Molecular Weight Heparin as an Alternative to Unfractionated Heparin in the Immediate Postoperative Period After Left Ventricular Assist Device Implantation

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Why the study?

Does low molecular weight heparin (nadroparin) provide safe and effective anticoagulation in the immediate postoperative period after LVAD implantation in patients with advanced heart failure?

Structured PICO

Does low molecular weight heparin (nadroparin) provide safe and effective anticoagulation in the immediate postoperative period after LVAD implantation in patients with advanced heart failure?

P

Population

8 consecutive patients undergoing left ventricular assist device (LVAD) implantation for advanced heart failure

I

Intervention

Low molecular weight heparin (nadroparin) given twice daily to achieve anti-Factor Xa activity target peak levels of 0.4 +/- 0.1 U/mL, combined with antiplatelet therapy consisting of aspirin (100 mg/day) and dipyridamole (3 x 75 mg/day)

O

Outcome

Bleeding and thrombotic events (major bleeding, minor bleeding, pump thrombosis, stroke)safety

Low molecular weight heparin (nadroparin) may provide a feasible alternative to unfractionated heparin for anticoagulation in the immediate postoperative period after LVAD implantation.

Implication

May support nadroparin feasibility post-LVAD without major bleeding; hypothesis-generating case series leaves efficacy versus heparin open.

Abstract

We present a regimen for anticoagulation in the immediate postoperative period after left ventricular assist device (LVAD) implantation using low molecular weight heparin (LMWH) as an alternative to unfractionated heparin. Between May and September 2007, eight consecutive patients undergoing LVAD implantation for advanced heart failure received the LMWH nadroparin. Nadroparin was given twice daily to achieve anti-Factor Xa activity target peak levels of 0.4 +/- 0.1 U/mL. The antiplatelet therapy consisted of aspirin (100 mg/day) and dipyridamole (3 x 75 mg/day). One patient underwent heart transplantation, three patients died, and four patients continued to receive device support. The median duration of support was 78 days (range, 46 to 174). No major bleeding was observed; minor bleeding occurred in three patients. In two patients, pump thrombosis was suspected. There were two ischemic and no hemorrhagic strokes. The use of LMWH may provide a new anticoagulation treatment option in the immediate postoperative period after LVAD implantation.