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A NEW ANTITHROMBOTIC STRATEGY FOR PATIENTS WITH LONG TERM MECHANICAL CIRCULATORY SUPPORT (MCS)
Abstract number: P-S-666
Boval1 B., Vermes2 E., Kirsch2 M., Loisance2 D., Drouet1 L.
11Haematology Lab, Hop. Lariboisiere, Paris 22Cardiac Surgery, Hop. H. Mondor, Créteil, France
How-to-cite Boval B, Vermes E, Kirsch M, Loisance D, Drouet L. A NEW ANTITHROMBOTIC STRATEGY FOR PATIENTS WITH LONG TERM MECHANICAL CIRCULATORY SUPPORT (MCS). J Thromb Haemost 2007; 5 Supplement 2: P-S-666
Abstract
Introduction: Patients with terminal heart failure on long term MCS are at high risk of thrombotic, haemorrhagic or infectious complications. The generally accepted antithrombotic treatment is based on oral anticoagulant (OAC) + aspirin. The difficulty in managing OAC during complications (infectious, cerebral or gastrointestinal bleedings) and frequency of thrombotic events led us to evaluate a new antithrombotic strategy.
Methods: Since 2003, all patients received anticoagulation with enoxaparin (adjusted to aXa level of 0.8 0.2 U/mL), aspirin (minimal dose to inhibit 0.2 mg/ml AA-induced platelet aggregation (PA)) and clopidogrel (minimal dose to inhibit > 50% 5 muM ADP-induced PA) shortly after MCS implantation. Additional monitoring tests included: D-Dimers, FVIIIc, fibrinogen, basal and 30 muM ADP-induced platelet CD62P, CD41 externalisation or platelet associated fibrinogen, and intra platelet Vasp expression.
Results: 10 patients were followed between 42 and 850 days. No patient experienced bleeding complications, 2 suffered a TIA during the search for optimal antiplatelet doses. Patients with improving kidney function required increased enoxaparin doses (maximum 100 U/kg bid) and patients with progressive kidney failure (chronically infected patients) required reduced enoxaparin doses (minimum 40 U/kg bid). Aspirin doses ranged from 100 to 450 mg/day and clopidogrel doses from 75 to 225 mg/day.
Conclusions: We show the feasibility, safety and stability of use of adjusted doses of enoxaparin and dual antiplatelet therapy in patients on long term MCS. Among the tests performed, some redundancy allows us to proposed a simplified and useful monitoring protocol. This strategy requires a larger multicenter evaluation.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
Session Details
| Date: |
01/08/2007
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| Time: |
00:00-00:00
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| Session name: |
XXIst ISTH Congress |
| Subject: |
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| Location: |
Oxford, UK |
| Presentation type: |
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