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Anticoagulation of patients treated with the Impella percutaneous mechanical circulatory support (MCS) devices is complex and lacks consistency across centers, potentially increasing the risk of complications. In order to optimize safety and efficacy, an expert committee synthesized all available evidence evaluating anticoagulation for patients receiving Impella support in order to provide consensus recommendations for the management of anticoagulation with these devices. The evidence synthesis led to the creation of 42 recommendations to improve anticoagulation management related to the use of the Impella devices. Recommendations address purge solution management, intravenous anticoagulation, monitoring, evaluation and management of heparin-induced thrombocytopenia (HIT), and management during combination MCS support. The use of a heparinized, dextrose-containing purge solution is critical for optimal device function, and a bicarbonate-based purge solution may be an alternative in certain situations. Likewise, intravenous (ie, systemic) anticoagulation with heparin is often necessary, although evidence supporting the optimal assay and target range for monitoring the level of anticoagulation is generally lacking. Patients treated with an Impella MCS device may develop HIT, which is more difficult to evaluate and treat in this setting. Lastly, the use of Impella with extracorporeal membrane oxygenation or for biventricular support creates additional anticoagulation challenges., (© 2021 Pharmacotherapy Publications, Inc.)

Background: The ClotCare Online Information Resource ("ClotCare") was established in 2000 as an interactive patient education service. In 2003, its scope of service was expanded to include clinicians and the general public, and an editorial board was added to facilitate dissemination of new information. By 2008, the site had achieved national and international recognition. Methods: Website use statistics and an online survey were used to assess geographic reach and clinical impact in 2010. Results: The site experienced an annual growth of over 40% (with the use doubling every 2 years). ClotCare answered over 1000 questions per year, web traffic exceeded 500 000 "hits" per month and more than 5000 individuals subscribed to the email list serve. Of the 826 individuals who responded to the survey, 55% subscribed to the email list serve, 58% were health care professionals, 31% were patients, and 11% were "individuals seeking information on blood clots and related issues". United States residents comprised 87% of respondents; the others resided in 20 different countries. Data from completed surveys revealed that 367 of 412 health care professionals (89%) and 259 of 298 patients (87%) could identify a specific change in practice that they had made due to information from ClotCare. Among the 295 "frequent users," 94% to 98% agreed or strongly agreed that ClotCare increased their knowledge, provided valuable information, provided trusted information, provided a valuable service, and is among the top five resources utilized for information on blood clots and related treatments. Conclusions: ClotCare substantially altered the actions of both health care professionals and patients. These outcomes have been achieved through web‐based education and information sharing as well as "on demand" responses to questions. ClotCare is a widely used resource that is highly valued. [ABSTRACT FROM AUTHOR]