Anticoagulation Monitoring in Left Ventricular Assist Device (LVAD) Patients

The use of left ventricular assist devices (LVAD) provides a treatment strategy for advanced heart failure patients to prolong life and serve as a mediator (bridge to transplant) until an organ becomes available in patients considered suitable candidates for heart transplantation. The use of LVAD therapy is complicated by the constant risk of bleeding and thrombotic events. We reviewed and analyzed the effectiveness of our current heparin protocol with respect to overall anticoagulation and time in therapeutic range (TTR). Our analysis demonstrated that patients did not achieve therapeutic anticoagulation for at least 24 hours following initiation of heparin and that only 40% of the time patients were considered therapeutic. Even after patients achieved a therapeutic activated plasma thromboplastin time (aPTT) TTR was only approximately 50% with less than 50% of tests resulting within range. Individual centers should perform ongoing assessment of effectiveness of individual heparin protocol for LVAD patients to ensure anticoagulation is optimized in these highly complex patients