biostudies-literatureUnknown2019Reed BN<h4>Objectives</h4>To characterize anticoagulation practices with the Impella percutaneous ventricular assist device (pVAD).<h4>Background</h4>Managing anticoagulation in patients being supported by the Impella pVAD is made challenging by several unique features of the device. These include the release of a dextrose-based purge solution containing unfractionated heparin (UFH), the need to concurrently administer systemic anticoagulation with intravenous UFH, and the lack of an alternative strategy in patients with contraindications to UFH.<h4>Methods</h4>To characterize anticoagulation practices with the Impella pVAD, we conducted a survey of centers in the United States performing a high volume of Impella cases, which we defined as > 1 per month. Centers were contacted via email or phone and individuals who agreed to participate were provided with a link to complete the survey online. The primary measures of interest were variations in practice across centers and variations from the manufacturer's recommendations.<h4>Results</h4>Practices varied considerably among respondents (65 of 182 centers, or 35.7%) and often diverged from manufacturer recommendations. Approximately half of centers (52.4%) reported using a UFH concentration of 50 units/mL in the purge solution, whereas most of the remaining centers (41.3%) reported using lower concentrations. Strategies for the initiation and adjustment of systemic therapy also varied, as did practices for routinely monitoring for hemolysis. Nearly one-fifth of centers (16.7%) had not developed an alternative strategy for the purge solution in patients with contraindications to UFH. Most centers (58.4%) reported using argatroban or bivalirudin in this scenario, a strategy that diverges from the manufacturer's recommendations.<h4>Conclusions</h4>Given these findings, studies to determine a systematic approach to anticoagulation with the Impella device are warranted.Journal of interventional cardiology3791307https://www.ebi.ac.uk/biostudies/studies/S-EPMC6739784biostudies-literatureSurvey of Anticoagulation Practices with the Impella Percutaneous Ventricular Assist Device at High-Volume Centers.PMC6739784DiDomenico RJCox JFOliphant CSJohnson DAllender JEJennings DLCoons JCReed BNfalseSurvey of Anticoagulation Practices with the Impella Percutaneous Ventricular Assist Device at High-Volume Centers.<h4>Objectives</h4>To characterize anticoagulation practices with the Impella percutaneous ventricular assist device (pVAD).<h4>Background</h4>Managing anticoagulation in patients being supported by the Impella pVAD is made challenging by several unique features of the device. These include the release of a dextrose-based purge solution containing unfractionated heparin (UFH), the need to concurrently administer systemic anticoagulation with intravenous UFH, and the lack of an alternative strategy in patients with contraindications to UFH.<h4>Methods</h4>To characterize anticoagulation practices with the Impella pVAD, we conducted a survey of centers in the United States performing a high volume of Impella cases, which we defined as > 1 per month. Centers were contacted via email or phone and individuals who agreed to participate were provided with a link to complete the survey online. The primary measures of interest were variations in practice across centers and variations from the manufacturer's recommendations.<h4>Results</h4>Practices varied considerably among respondents (65 of 182 centers, or 35.7%) and often diverged from manufacturer recommendations. Approximately half of centers (52.4%) reported using a UFH concentration of 50 units/mL in the purge solution, whereas most of the remaining centers (41.3%) reported using lower concentrations. Strategies for the initiation and adjustment of systemic therapy also varied, as did practices for routinely monitoring for hemolysis. Nearly one-fifth of centers (16.7%) had not developed an alternative strategy for the purge solution in patients with contraindications to UFH. Most centers (58.4%) reported using argatroban or bivalirudin in this scenario, a strategy that diverges from the manufacturer's recommendations.<h4>Conclusions</h4>Given these findings, studies to determine a systematic approach to anticoagulation with the Impella device are warranted.2019-01-01T00:00:00Z20192025-05-29T20:23:56.178Z2025-05-29T20:23:56.178ZS-EPMC67397843177252910.1155/2019/3791307