Introduction Although anticoagulation therapy is mandated after implantation of a left ventricular assist device (LVAD), postoperative bleedings and reoperations occur relatively frequently and are associated with worse outcomes. We evaluated the use of a conservative postoperative anticoagulation protocol in patients implanted with a HeartMate 3 (HM3) LVAD. Methods In a single-centre retrospective analysis of postoperative outcomes after HM3 LVAD implantation, a standard (old) anticoagulation protocol (i.e. early, full-dose anticoagulation with low-molecular weight heparin and overlapping vitamin K antagonist) was compared with a new conservative anticoagulation protocol (i.e. slow initiation of vitamin K antagonists without overlapping heparin). Main outcomes were changes in international normalised ratio (INR), lactate dehydrogenase (LDH), bleeding and/or tamponade events requiring reoperation, length of stay and adverse events. Results In total, 73 patients (48 in old vs 25 in new protocol group) were evaluated. Mean age was 56 years (standard deviation 13) and most patients (78%) were males. Changes in INR and LDH in the first 14 days were similar in both groups (p = 0.50 and p = 0.997 for interaction, respectively). Number of bleeding/tamponade events requiring reoperation was lower in the new than in the old protocol group (4% vs 33%, p = 0.005). Postoperative 30-day mortality was similar, and we observed no thromboembolic events. Median (25th-75th percentiles) total length of postoperative hospital stay (27 (25-41) vs 21 (19-27) days, p < 0.001) and length of intensive care unit stay (5 (2-9) vs 2 (2-5) days, p = 0.022) were significantly shorter in the new protocol group. Conclusion These retrospective data suggest that conservative slow initiation of anticoagulation therapy after HM3 LVAD implantation is associated with less bleeding/tamponade events requiring reoperation, a similar safety profile and a shorter duration of stay than the currently advised standard anticoagulation protocol.
机构:
Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Morgan, Jeffrey A.
Paone, Gaetano
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Paone, Gaetano
Nemeh, Hassan W.
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Nemeh, Hassan W.
Henry, Scott E.
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Henry, Scott E.
Patel, Rosan
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Patel, Rosan
Vavra, Jessica
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Vavra, Jessica
Williams, Celeste T.
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Henry Ford Hosp, Div Cardiovasc Med, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Williams, Celeste T.
Lanfear, David E.
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Henry Ford Hosp, Div Cardiovasc Med, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Lanfear, David E.
Tita, Cristina
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Henry Ford Hosp, Div Cardiovasc Med, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Tita, Cristina
Brewer, Robert J.
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
机构:
Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Feng, Iris
Kurlansky, Paul A.
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Columbia Univ, Ctr Innovat & Outcomes Res, Dept Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Kurlansky, Paul A.
Powley, Tanner R.
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Powley, Tanner R.
Hynds, Melissa A.
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Hynds, Melissa A.
Yang, Christine G.
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Yang, Christine G.
Eisenberger, Andrew
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Columbia Univ, Irving Med Ctr, Dept Med, Div Hematol Oncol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Eisenberger, Andrew
Hastie, Jonathan M.
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Columbia Univ, Irving Med Ctr, Dept Anesthesiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Hastie, Jonathan M.
Sutherland, Lauren D.
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Columbia Univ, Irving Med Ctr, Dept Anesthesiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Sutherland, Lauren D.
Yuzefpolskaya, Melana
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Columbia Univ, Irving Med Ctr, Dept Med, Div Cardiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Yuzefpolskaya, Melana
Colombo, Paolo C.
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Columbia Univ, Irving Med Ctr, Dept Med, Div Cardiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Colombo, Paolo C.
Sayer, Gabriel T.
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Columbia Univ, Irving Med Ctr, Dept Med, Div Cardiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Sayer, Gabriel T.
Uriel, Nir Y.
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Columbia Univ, Irving Med Ctr, Dept Med, Div Cardiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Uriel, Nir Y.
Naka, Yoshifumi
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Naka, Yoshifumi
Takeda, Koji
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
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Univ Louisville, Div Thorac & Cardiovasc Surg, 201 Abraham Flexner Way,Suite 1200, Louisville, KY 40202 USAUniv Louisville, Div Thorac & Cardiovasc Surg, 201 Abraham Flexner Way,Suite 1200, Louisville, KY 40202 USA
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Univ Kansas, Med Ctr, Dept Anesthesiol, 3901 Rainbow Blvd, Kansas City, KS 66160 USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Wei, Johnny
Franke, Jack
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
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Kee, Abigail
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Kee, Abigail
Dukes, Rachel
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Dukes, Rachel
Leonardo, Vincent
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
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Flynn, Brigid C.
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Morgan, Jeffrey A.
Paone, Gaetano
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Paone, Gaetano
Nemeh, Hassan W.
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Nemeh, Hassan W.
Henry, Scott E.
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Henry, Scott E.
Patel, Rosan
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Patel, Rosan
Vavra, Jessica
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Vavra, Jessica
Williams, Celeste T.
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Henry Ford Hosp, Div Cardiovasc Med, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Williams, Celeste T.
Lanfear, David E.
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Henry Ford Hosp, Div Cardiovasc Med, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Lanfear, David E.
Tita, Cristina
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Henry Ford Hosp, Div Cardiovasc Med, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
Tita, Cristina
Brewer, Robert J.
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Henry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USAHenry Ford Hosp, Div Cardiothorac Surg, Inst Heart & Vasc, Detroit, MI 48202 USA
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Feng, Iris
Kurlansky, Paul A.
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Columbia Univ, Ctr Innovat & Outcomes Res, Dept Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Kurlansky, Paul A.
Powley, Tanner R.
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Powley, Tanner R.
Hynds, Melissa A.
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Hynds, Melissa A.
Yang, Christine G.
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Yang, Christine G.
Eisenberger, Andrew
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Columbia Univ, Irving Med Ctr, Dept Med, Div Hematol Oncol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Eisenberger, Andrew
Hastie, Jonathan M.
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Columbia Univ, Irving Med Ctr, Dept Anesthesiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Hastie, Jonathan M.
Sutherland, Lauren D.
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Columbia Univ, Irving Med Ctr, Dept Anesthesiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Sutherland, Lauren D.
Yuzefpolskaya, Melana
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Columbia Univ, Irving Med Ctr, Dept Med, Div Cardiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Yuzefpolskaya, Melana
Colombo, Paolo C.
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Columbia Univ, Irving Med Ctr, Dept Med, Div Cardiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Colombo, Paolo C.
Sayer, Gabriel T.
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Columbia Univ, Irving Med Ctr, Dept Med, Div Cardiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Sayer, Gabriel T.
Uriel, Nir Y.
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Columbia Univ, Irving Med Ctr, Dept Med, Div Cardiol, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Uriel, Nir Y.
Naka, Yoshifumi
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
Naka, Yoshifumi
Takeda, Koji
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Columbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USAColumbia Univ, Irving Med Ctr, Dept Surg, Div Cardiothorac & Vasc Surg, New York, NY USA
机构:
Univ Louisville, Div Thorac & Cardiovasc Surg, 201 Abraham Flexner Way,Suite 1200, Louisville, KY 40202 USAUniv Louisville, Div Thorac & Cardiovasc Surg, 201 Abraham Flexner Way,Suite 1200, Louisville, KY 40202 USA
机构:
Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Univ Kansas, Med Ctr, Dept Anesthesiol, 3901 Rainbow Blvd, Kansas City, KS 66160 USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Wei, Johnny
Franke, Jack
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Franke, Jack
Kee, Abigail
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Kee, Abigail
Dukes, Rachel
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Dukes, Rachel
Leonardo, Vincent
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA
Leonardo, Vincent
Flynn, Brigid C.
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Univ Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USAUniv Kansas, Med Ctr, Dept Anesthesiol, Kansas City, KS USA