Coagulation management in patients undergoing mechanical circulatory support.

Area of Science:

• Cardiology
• Hematology
• Medical Devices

Background:

• High incidence of bleeding and thrombo-embolic complications in mechanical circulatory support (MCS) patients.
• Conventional coagulation tests are insufficient for monitoring haemostasis in MCS patients.
• Variability in anticoagulation needs across different MCS devices (VADs, ECMO).

Purpose of the Study:

• To highlight the limitations of conventional coagulation tests in MCS therapy.
• To emphasize the utility of point-of-care (POC) haemostatic tests for improved patient management.
• To recommend repeated monitoring of haemostasis using POC tests to reduce adverse events.

Main Methods:

• Utilizing whole blood viscoelastic tests (thromboelastometry/thromboelastography) for detailed haemostatic status assessment.
• Employing platelet function tests (impedance or turbidimetric aggregometry) to evaluate anti-platelet therapy efficacy.
• Repeatedly performing POC tests to account for inter- and intra-individual variability in coagulation parameters.

Main Results:

• POC tests provide a comprehensive view of haemostasis, including fibrinolysis, hypercoagulability, clot firmness, and platelet response.
• Conventional tests often show normal values despite ongoing thrombo-embolic complications.
• POC testing aids in guiding goal-directed therapy for bleeding patients, optimizing blood product and drug administration.

Conclusions:

• Monitoring haemostasis with POC thromboelastometry/thromboelastography and platelet function analysis is recommended during MCS therapy.
• POC testing helps mitigate risks of bleeding and thrombo-embolic complications, improving patient outcomes.
• Development of protocols based on POC testing is beneficial for managing coagulation in MCS patients.