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Outcomes of systemic bivalirudin and sodium bicarbonate purge solution for Impella 5.5.
- Source :
-
Artificial organs [Artif Organs] 2023 Feb; Vol. 47 (2), pp. 361-369. Date of Electronic Publication: 2022 Oct 31. - Publication Year :
- 2023
-
Abstract
- Background: Impella 5.5 (Abiomed; Danvers, MA) (IMP5) is a commonly used, surgically implanted, tMCS device that requires systemic anticoagulation and purge solution to avoid pump failure. To avoid heparin-induced thrombocytopenia (HIT) from unfractionated heparin (UFH) use, our program has explored the utility of bivalirudin (BIV) for systemic anticoagulation and sodium bicarbonate-dextrose purge solution (SBPS) in IMP5.5.<br />Methods: This single center, retrospective study included 34 patients supported on IMP5.5 with BIV based AC and SBPS between December 1st 2020 to December 1st 2021.The efficacy and safety end points were incidence of development of HIT, Tissue Plasminogen Activator (tPA) use for suspected pump thrombosis, stroke, and device failure as well as clinically significant bleeding.<br />Results: The median duration of IMP5.5 support was 9.8 days (IQR: 6-15). Most patients were bridged to HTX (58%) followed by recovery (27%) and LVAD implantation (15%). Patients were therapeutic on bivalirudin for 64% of their IMP5.5 support. One patient (2.9%) suffered from ischemic stroke and 26.5% (9) patients developed clinically significant bleeding. tPA was administered to 7(21%) patients. One patient in the entire cohort developed HIT.<br />Conclusions: Our experience supports the use of systemic BIV and SBPS as a method to avoid heparin exposure in a patient population predisposed to the development of HIT.<br /> (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
- Subjects :
- Humans
Anticoagulants adverse effects
Tissue Plasminogen Activator adverse effects
Sodium Bicarbonate
Retrospective Studies
Hirudins adverse effects
Peptide Fragments adverse effects
Hemorrhage chemically induced
Recombinant Proteins adverse effects
Treatment Outcome
Heparin adverse effects
Thrombocytopenia
Subjects
Details
- Language :
- English
- ISSN :
- 1525-1594
- Volume :
- 47
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Artificial organs
- Publication Type :
- Academic Journal
- Accession number :
- 36271639
- Full Text :
- https://doi.org/10.1111/aor.14428