Effect of Platelet Inhibitors on Thromboembolism After Implantation of a Novacor N100 - Preliminary Results

Schmid, Çhristof; Weyand, M; Hammel, Dieter; Mc, Deng; Nabavi, Darius G.; Hh, Scheld

doi:10.1055/s-2007-1010235

Cited by 25 publications

(8 citation statements)

References 4 publications

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“…Despite significant progress, anticoagulation and its monitoring remain a major problem. 12,24,[49][50][51][52] Heparin coating alone has not solved all the problems. In both periods, pumps had to be exchanged when significant thrombus formation became visible, although this rate significantly decreased during period II.…”

Section: Discussionmentioning

confidence: 99%

Single-center experience with treatment of cardiogenic shock in children by pediatric ventricular assist devices

Hetzer

Potapov

Alexi-Meskishvili

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Single-center experience with treatment of cardiogenic shock in children by pediatric ventricular assist devices

Hetzer

Potapov

Alexi-Meskishvili

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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“…Anticoagulation and its monitoring remain a major problem despite significant progress in this field (38,41,(59)(60)(61)(62). Heparin coating alone has not resolved all the problems.…”

Section: Anticoagulationmentioning

confidence: 99%

Ventricular assist devices in children: Current achievements and future perspectives

Potapov¹,

Stiller²,

Hetzer³

2007

Pediatric Transplantation

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Mechanical circulatory support systems for the treatment of acute and chronic heart failure are now available for use in several clinical situations and are designed for different indications and support times. In children, particularly in small infants, extracorporeal membrane oxygenation and centrifugal pumps have been most widely used in the past. These systems are preferred for support after cardiac operations and for use in patients who have concomitant respiratory failure, but they are suitable for short-term application only and intensive care is obligatory. VADs are designed for long-term application and allow patients to be discharged home. Pneumatic pulsatile VADs have been available in pediatric sizes since 1992. Currently at our institution, 74 children have been supported with pediatric extracorporeal VADs for up to 14 months. In the past five yr, a notable rise in survival has been achieved by improvements in pump design and pre- and post-operative management. We have been able to discharge 78% of the infants under one yr old. In this review, our current VAD experience in children will be presented in the light of improvements in decision-making, device technology, and implantation techniques, and in coagulation monitoring and anticoagulation. Additionally, new developments in the field of pediatric assist devices will be presented.

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“…An antithrombotic protocol including platelet inhibitors is essential during mechanical circulatory support to prevent thromboembolic complications. 5,25 Anticoagulant monitoring is relatively well-standardized, albeit sometimes more difficult in children than in adults. 26 In contrast, antiplatelet-drug monitoring remains an issue.…”

Section: Discussionmentioning

confidence: 99%

Platelet‐mapping assay for monitoring antiplatelet therapy during mechanical circulatory support in children: A retrospective observational study

Giorni¹,

Costopoulos

Bachelot‐Loza

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Thromboelastography (TEG)‐platelet mapping (PM) assay is used for antiplatelet‐drug monitoring.The TEG‐PM was evaluated for dypiridamole and aspirin monitoring in 4 BH‐implanted children.Some TEG‐PM tracings were atypical leading to wrong results.The TEG‐PM has to be improved for antiplatelet‐drug monitoring during ventricular assistance. IntroductionThe complex hemostatic changes associated with Berlin Heart (BH) implantation in children require a challenging antithrombotic treatment. The aim of this retrospective analysis was to evaluate the thromboelastography (TEG)‐platelet mapping (PM) assay to monitor antiplatelet therapy in children implanted with a BH.Methods TEG‐PM was performed in 4 BH‐implanted patients receiving dipyridamole and aspirin, and 9 healthy volunteers. Patients’ antiplatelet therapy was adjusted to TEG‐PM results. Light transmission aggregometry (LTA) was also available for 2 of these patients.ResultsBetween 2009 and 2014, 4 BH‐implanted patients received a dual antiplatelet therapy monitored by TEG‐PM. In 2 patients, 18 of 34 tracings were atypical, because the maximum amplitude due to fibrin never stabilized, which made difficult antiplatelet therapy adjustment as recommended by BH's guidelines. To overcome this difficulty, TEG‐PM and LTA were next performed in parallel. However, both methods led to different decisions to adjust antiplatelet therapy in 57% of the cases. In order to better understand this atypical tracing, TEG‐PM was also performed in 9 volunteers and surprisingly 3 of them had the same atypical tracing. This atypical tracing was corrected by adding apyrase, suggesting that adenosine diphosphate (ADP) participates to spontaneous platelet activation in heparinized samples. In addition, we evidenced a high variability in the responses of TEG‐PM with ADP in volunteers.ConclusionsAntiplatelet therapy monitoring in BH‐implanted children remains challenging, as TEG‐PM is sensitive to several preanalytical and analytical conditions.

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Effect of Platelet Inhibitors on Thromboembolism After Implantation of a Novacor N100 - Preliminary Results

Abstract: Addition of platelet inhibitors to heparin/phenprocoumon effectively prevents thromboembolism. However, platelet inhibitors should be postponed until sufficient hemostasis is achieved, since too early administration is associated with an increased risk of bleeding.

Cited by 25 publications

References 4 publications

Single-center experience with treatment of cardiogenic shock in children by pediatric ventricular assist devices

Single-center experience with treatment of cardiogenic shock in children by pediatric ventricular assist devices

Ventricular assist devices in children: Current achievements and future perspectives

Platelet‐mapping assay for monitoring antiplatelet therapy during mechanical circulatory support in children: A retrospective observational study

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