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In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
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Low-Dose Prothrombin Complex Concentrate in Patients with Left Ventricular Assist Devices
Caitlin S Brown1, Wesley R Zemrak2, Kaitlin J Dyer3
1From the Department of Pharmacy, Mayo Clinic, Rochester, Minnesota.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|March 22, 2018
Summary
Low-dose 4-factor prothrombin complex concentrate (4F-PCC) effectively reversed warfarin in two left ventricular assist device (LVAD) patients needing urgent procedures. This approach avoided thrombotic complications, suggesting a potential safe strategy for managing bleeding risks in LVAD recipients.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Left ventricular assist devices (LVADs) are crucial for end-stage heart failure but necessitate anticoagulation, increasing bleeding risks.
- Warfarin is commonly used for anticoagulation in LVAD patients, requiring careful management of its reversal.
- Prothrombin complex concentrate (PCC) is used for warfarin reversal, but thrombotic risks exist, particularly in high-risk patients.
Observation:
- Two patients with Heart Mate II LVADs on warfarin required urgent reversal due to bleeding or procedural needs.
- One patient had an INR of 4.7, the other 3.7; both received low-dose 4-factor PCC (4F-PCC).
Findings:
- The first patient received ~16 units/kg of 4F-PCC, achieving INR reversal to 2.3 within 45 minutes.
- The second patient received ~11 units/kg of 4F-PCC, with INR reversal to 1.6 within 1 hour.
- Neither patient experienced thrombotic complications following 4F-PCC administration.
Implications:
- Low-dose 4F-PCC appears to be a safe and effective option for urgent warfarin reversal in LVAD patients.
- This strategy may mitigate bleeding risks without inducing thrombosis in this vulnerable population.
- Further research into optimal low-dose 4F-PCC dosing for LVAD patients is warranted.
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