Evidence map›Paper›PMID 35380415›Full record

ArticleNetherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation2022

Conservative initial postoperative anticoagulation strategy after HeartMate 3 left ventricular assist device implantation.

Kevin Damman, Stan A J van den Broek, Gianclaudio Mecozzi, Joep M Droogh, Ethel Metz, Annemieke Oude Lansink, Jan A Krikken, Michiel E Erasmus, Michiel Kuijpers

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Article in Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Kevin DammanDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. k.damman@umcg.nl.ORCID http://orcid.org/0000-0003-0190-2228
Stan A J van den BroekDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Gianclaudio MecozziDepartment of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Joep M DrooghDepartment of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ethel MetzDepartment of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Annemieke Oude LansinkDepartment of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Jan A KrikkenDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Michiel E ErasmusDepartment of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Michiel KuijpersDepartment of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAlthough anticoagulation therapy is mandated after implantation of a left ventricular assist device (LVAD), postoperative bleedings and reoperations occur relatively frequently and are associated with worse outcomes. We evaluated the use of a conservative postoperative anticoagulation protocol in patients implanted with a HeartMate 3 (HM3) LVAD.

methodsIn a single-centre retrospective analysis of postoperative outcomes after HM3 LVAD implantation, a standard (old) anticoagulation protocol (i.e. early, full-dose anticoagulation with low-molecular weight heparin and overlapping vitamin K antagonist) was compared with a new conservative anticoagulation protocol (i.e. slow initiation of vitamin K antagonists without overlapping heparin). Main outcomes were changes in international normalised ratio (INR), lactate dehydrogenase (LDH), bleeding and/or tamponade events requiring reoperation, length of stay and adverse events.

resultsIn total, 73 patients (48 in old vs 25 in new protocol group) were evaluated. Mean age was 56 years (standard deviation 13) and most patients (78%) were males. Changes in INR and LDH in the first 14 days were similar in both groups (p = 0.50 and p = 0.997 for interaction, respectively). Number of bleeding/tamponade events requiring reoperation was lower in the new than in the old protocol group (4% vs 33%, p = 0.005). Postoperative 30-day mortality was similar, and we observed no thromboembolic events. Median (25th-75th percentiles) total length of postoperative hospital stay (27 (25-41) vs 21 (19-27) days, p < 0.001) and length of intensive care unit stay (5 (2-9) vs 2 (2-5) days, p = 0.022) were significantly shorter in the new protocol group.

conclusionThese retrospective data suggest that conservative slow initiation of anticoagulation therapy after HM3 LVAD implantation is associated with less bleeding/tamponade events requiring reoperation, a similar safety profile and a shorter duration of stay than the currently advised standard anticoagulation protocol.

Indexed as

AnticoagulationHeartMate 3LVAD

Identifiers

PMID35380415
PMCPMC9475015

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