Research Article
Survey of Anticoagulation Practices with the Impella Percutaneous Ventricular Assist Device at High-Volume Centers
| | Anticoagulation Practice | Centers (%) |
| | Default purge heparin concentrations (n=63) | | | 0 units/mL | 3 (4.8%) | | 12.5 units/mL | 8 (12.7%) | | 25 units/mL | 18 (28.6%) | | 50 units/mL | 33 (52.4%) | | Other | 1 (1.6%) |
| | Alternative purge in patients with a contraindication to heparin (n=60) | | | Remove anticoagulant from purge | 15 (25.0%) | | Argatroban | 22 (36.7%) | | Bivalirudin | 6 (10.0%) | | Either argatroban or bivalirudin | 7 (11.7%) | | No strategy developed for this scenario | 10 (16.7%) |
| | Timing of intravenous heparin initiation (n=61) | | | At device insertion, prior to assessing anticoagulation status | 23 (37.7%) | | Only after the patient is subtherapeutic on the purge solution alone | 30 (49.2%) | | Other | 8 (13.1%) |
| | Bolus of heparin administered during intravenous administration (n=61) | 11 (18.0%) |
| | Intravenous heparin adjusted for initial purge flow (n=61) | 36 (59.0%) |
| | Default heparin monitoring (n=60) | | | Activated partial thromboplastin time | 34 (56.7%) | | Anti-Xa concentration | 8 (13.3%) | | Activated clotting time | 13 (21.7%) | | Other | 5 (8.3%) |
| | Monitoring for hemolysis is performed routinely (n=60) | 26 (43.3%) |
| | Hemolysis laboratories monitored (n=26) | | | Lactate dehydrogenase | 26 (100.0%) | | Indirect bilirubin | 13 (50.0%) | | Serum haptoglobin | 10 (38.5%) | | Plasma free hemoglobin | 2 (7.7%) |
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