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Updated: Nov 12, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Hemostatic Challenges in Pediatric Critical Care Medicine-Hemostatic Balance in VAD
Muhammad Bakr Ghbeis1, Christina J Vander Pluym2, Ravi Ram Thiagarajan1
1Division of Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
Insights
Managing children with ventricular assist devices (VADs) requires safe anticoagulation. Shifting from heparin to direct thrombin inhibitors like bivalirudin has reduced bleeding and clotting complications in pediatric VAD patients.
Area of Science:
- Pediatric cardiology
- Biomaterials science
- Pharmacology
Background:
- Ventricular assist devices (VADs) are increasingly used in pediatric patients.
- Effective anticoagulation is crucial for managing children with VADs.
- Challenges include developmental hemostasis, device hemocompatibility, and variable protocols, leading to bleeding and thromboembolic events.
Purpose of the Study:
- To review the complexities of anticoagulation in pediatric VAD patients.
- To highlight the role of collaborative networks like ACTION in improving outcomes.
- To discuss the shift in anticoagulation strategies and their impact.
Main Methods:
- Review of existing literature on pediatric VAD anticoagulation.
- Analysis of factors contributing to adverse events.
- Examination of the impact of changing anticoagulation protocols.
Main Results:
- Pediatric VAD patients face unique anticoagulation challenges.
- Collaborative networks facilitate best practice development.
- Transitioning to direct thrombin inhibitors (DTIs) like bivalirudin has decreased complications compared to heparin.
Conclusions:
- Optimizing anticoagulation in pediatric VADs is essential for patient safety.
- Collaborative efforts and updated strategies, such as using DTIs, improve VAD management.
- Further research and standardized protocols are needed to minimize adverse events.
Abstract:
Ventricular assist devices (VAD) are used more in children. Safe and effective anticoagulation is required for successful management of children supported with ventricular assist devices. Developmental hemostasis, device hemocompatibility, plastic to body ratio, surgical variable techniques, lack of knowledge on pharmacokinetics of anticoagulants, and wide variability in anticoagulation protocols have all contributed to increased incidence of bleeding and thromboembolic complications. New collaborative learning networks, such as the ACTION network, provide opportunities to define best practices, optimize, and reduce anticoagulation related adverse events. ACTION was established Dec 2017. It consists of expert clinicians in heart failure, as well as researchers, parents, and patients, with goals to improve outcomes, share data, improve education and standard practice for children with heart failure (, n.d). Changes in pediatric VAD anticoagulation strategy from using mainly heparin to DTI such as bivalirudin have helped reduce bleeding and clotting complications.
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