Blutgerinnungsstörungen unter ECMO- und LVAD-Therapie

Straub, Andreas

doi:10.1055/a-0736-7202

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…Although hematuria and melena are lower in incidence than INR issues (<23% vs. >85%), these signs are crucial for clinicians to anticipate and teach patients and their caregivers the appropriate monitoring and reporting for early intervention of coagulopathy. 21 Our data also suggest that, despite an LVAD, heart failure symptoms were prevalent during the 6 months postdischarge, as demonstrated by 53–82% of patients had issues with weight gain (day 0 to 6 months) and edema (day 0 to 3 months).…”

Section: Discussionsupporting

confidence: 69%

“…16,17 The high prevalence of abnormal INR levels throughout 6 months may be attributed to many factors of managing and titrating anticoagulants, a well-understood problem in the LVAD population. 21,27 Finally, the mechanism by which heart failure symptoms were overt during the study requires more scrutiny from the many angles of patient care: the physiologic level, the patient's health behavior (e.g., selfefficacy and adherence), psychoeducational and therapeutic support (VAD care team), social support (caregiver), and the healthcare delivery system. 17,28 Social determinants of health 29 may also play a factor in heart failure symptom prevalence as 12-23% of patients had medication intake issues due to delay in prescription refills or health insurance issues.…”

Section: Discussionmentioning

confidence: 99%

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Patient-Reported Issues Following Left Ventricular Assist Device Implantation Hospitalization

et al. 2021

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The purpose of this study was to explore the information reported by patients via a smartphone application (VAD Care App) used for left ventricular assist device (LVAD) self-care monitoring and reporting post hospital discharge. Specific aims were to examine the type and frequency of issues reported by patients through the app during months 1, 3, and 6 postdischarge. An exploratory-descriptive research design was used with 17 patients (12 males and 5 females) with durable LVADs, mean age of 48.6 ± 16 years. Data generated by the patients' daily smartphone app usage more than 6 months were extracted from the server. Data were coded and clustered according to issues reported by patients via the app and analyzed with descriptive statistics. Three clusters of issues were found: physiologic, behavioral (self-care), and signs and symptoms. LVAD flows and pulsatility indices, hypertension, driveline care, and heart failure symptoms were worse at month 1, and then appeared to improve at months 3-6. However, abnormal levels of the international normalization ratio were common at all assessment points. Further research is needed to understand the mechanism of the reported issues on treatment outcomes, then develop and test interventions to inform evidence-based practice and clinical guidelines for smartphone apps used in LVAD self-care monitoring. ASAIO

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Patient-Reported Issues Following Left Ventricular Assist Device Implantation Hospitalization

et al. 2021

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Perioperative Gerinnungsstörungen: Diagnostik und Therapie

Keller¹,

Magunia²

2019

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungDie Behandlung von Blutungen im Rahmen einer Operation ist eine der Kernaufgaben des Anästhesisten. Neben der ständigen Kommunikation mit dem Operateur ist hierfür ein fundiertes Verständnis der vielfältigen Ursachen essenziell, um einen schnellstmöglichen Behandlungserfolg zu erzielen. Der Beitrag stellt die wichtigsten Zusammenhänge zur Diagnostik und Therapie perioperativer Blutungen dar.

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Multi-Modal Characterization of the Coagulopathy Associated With Extracorporeal Membrane Oxygenation

Granja

Hohenstein

Schüssel

et al. 2020

Critical Care Medicine

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Objectives: Extracorporeal membrane oxygenation is used to stabilize severe cardiocirculatory and/or respiratory failure. However, extracorporeal membrane oxygenation is associated with a coagulopathy characterized by thromboembolic and hemorrhagic complications. This study aimed to characterize the pathomechanism of the extracorporeal membrane oxygenation-associated coagulopathy and identify options to optimize its monitoring and therapy. Design: Prospective observational clinical trial. Setting: ICU of a university hospital. Patients: Patients treated with venovenous extracorporeal membrane oxygenation (n = 10) due to acute respiratory distress syndrome and patients treated with venoarterial extracorporeal membrane oxygenation (n = 8) due to cardiocirculatory failure. One patient per group (venovenous extracorporeal membrane oxygenation or venoarterial extracorporeal membrane oxygenation) had surgery before extracorporeal membrane oxygenation. Interventions: Blood was sampled before, and 1, 24, and 48 hours after extracorporeal membrane oxygenation implantation. Point-of-care tests (thrombelastometry/platelet aggregometry), conventional coagulation tests, whole blood counts, and platelet flow cytometry were performed. Measurements and Main Results: Even before extracorporeal membrane oxygenation, plasmatic coagulation and platelet aggregation were impaired due to systemic inflammation, liver failure, anticoagulants (heparins, phenprocoumon, apixaban), and antiplatelet medication. During extracorporeal membrane oxygenation, hemodilution and contact of blood components with artificial surfaces and shear stress inside extracorporeal membrane oxygenation additionally contributed to coagulation and platelet defects. Fibrinogen levels, fibrin polymerization, platelet activation, and microparticle release were increased in venovenous extracorporeal membrane oxygenation compared to venoarterial extracorporeal membrane oxygenation patients. Point-of-care results were available faster than conventional analyses. Bleeding requiring blood product application occurred in three of 10 venovenous extracorporeal membrane oxygenation patients and in four of eight venoarterial extracorporeal membrane oxygenation patients. No thrombotic events were observed. In-hospital mortality was 30% for venovenous extracorporeal membrane oxygenation and 37.5% for venoarterial extracorporeal membrane oxygenation patients. Conclusions: The extracorporeal membrane oxygenation-associated coagulopathy is a multifactorial and quickly developing syndrome. It is characterized by individual changes of coagulation parameters and platelets and is aggravated by anticoagulants. The underlying factors of the extracorporeal membrane oxygenation-associated coagulopathy differ between venovenous extracorporeal membrane oxygenation and venoarterial extracorporeal membrane oxygenation patients and are best diagnosed by a combination of point-of-care and conventional coagulation and platelet analyses. Therapy protocols for treating extracorporeal membrane oxygenation-associated coagulopathy should be further validated in large-scale prospective clinical investigations.

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Blutgerinnungsstörungen unter ECMO- und LVAD-Therapie

Cited by 4 publications

References 20 publications

Patient-Reported Issues Following Left Ventricular Assist Device Implantation Hospitalization

Patient-Reported Issues Following Left Ventricular Assist Device Implantation Hospitalization

Perioperative Gerinnungsstörungen: Diagnostik und Therapie

Multi-Modal Characterization of the Coagulopathy Associated With Extracorporeal Membrane Oxygenation

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