Anticoagulation for mechanical circulatory support

Abstract

Clinically significant thromboembolic events continue to be a devastating complication during Ventricular Assist Device (VAD) support. Despite monumental advances in mechanical circulatory support technology, the monitoring and management of coagulation in the presence of substantial foreign material remains an ongoing challenge. Furthermore, the peculiarity of hemostasis in children places these patients at increased risk of devastating complications even in the presence of standard anticoagulation regimes. Pre-existing coagulation abnormalities due to renal and hepatic dysfunction, exacerbated with depletion of clotting factors secondary to cardiopulmonary bypass and altered rheological state all conspire to increase bleeding in the perioperative time period. These considerations must be weighted with the eminent risk of clot formation and thromboembolic events over time.