COAGULATION MANAGEMENT IN PATIENTS WITH THE AXIAL FLOW PUMP BERLIN HEART INCOR

Abstract

Purpose: We present the first results of our coagulation management in patients with the new axial flow pump Berlin Heart Incor. Methods: Between June and December 2002 the new axial flow pump was implanted in six patients. The diagnosis in three patients was dilatative cardiomyopathy (CMP) and in three ischemic CMP. The group was treated with a new anticoagulation concept consisting of anti-aggregation, anti-adhesion and anti-coagulation drugs and of rheologica. The mean support time was 110 days. Results: After the first two postoperative days the mean platelet count was 155.000/μl and results in platelet aggregation tests were normal, so that early anti-aggregation therapy with aspirin was necessary. Nevertheless one patient suffered a transient ischemic attack (TIA) on the eighth postoperative day. In total, four TIAs occurred in three patients (50%). In all these cases platelet anti-aggregation therapy was insufficient. No patient presented apoplexia and no patient died. None of the patients had to be reopened and none had gastrointestinal bleeding. In two patients transient epistaxis was seen. Four patients have left hospital; two are in the early postoperative stage. In one patient myocardial recovery occurred and the pump could be explanted. With the new axial flow pump Berlin Heart Incor early postoperative platelet recovery was seen, requiring early anti-aggregation therapy. Our coagulation protocol minimized the incidence of bleeding and embolic complications. It ensures the survival of the patients on MCS, is easy to perform, is not expensive and enables patients to be discharged home.