REDUCTION OF HEMORRHAGIC COMPLICATIONS DURING MECHANICALLY ASSISTED CIRCULATION WITH THE USE OF A MULTISYSTEM ANTICOAGULATION PROTOCOL

Two different anticoagulation protocols were used in 49 consecutive pa tients mechanically supported either for bridge to transplantation (II ) or for recovery of myocardial function after cardiac surgery (35). I n 46 patients a Biomedicus centrifugal pump was used and in 3 patients a Pierce-Donachy ventricles. Mechanical support was provided to the l eft ventricle in 14 patients, to the right ventricle in 6 and to both ventricles in 12 patients; an extra-corporeal membrane oxygenator (ECM O) support was used in 17 patients. Thirty-seven males and 12 females, aged 0.2 to 58 years, were supported for an average time of 6.3 days (range 1-43). Anticoagulation was either based on a continuous infusio n of heparin in the first 27 patients (group A) or on a multi-system t herapy (''La Pitie'' protocol) in the other 22 patients (group B). Ove rall survival rate was 47%. Patients in group A had a 30% (8/27) survi val rate, whereas in group B a 68% (15/22) survival rate was observed (p=0.006). Transplantation and ventricular assist device (VAD) removal was successfully obtained in 59% (16/27) and 91% (20/22) of patients in group A and group B respectively (p=0.05). Significant bleeding occ urred in 21 patients (81%) in group A and in 2 (9%) of group B (p=0.00 1). In these patients bleeding averaged 230 +/- 231 ml/kg in group A v ersus 55 +/- 18 ml/kg in group B (p=0.001). Surgical revision was nece ssary for cardiac tamponade or persistent bleeding in 12 patients of g roup A (25 procedures: mean 0.9/patient) and in 3 patients of group B (one each patient: mean 0.1/patient) (p=0.01). Infection, thrombo-embo lism and brain hemorrhage were also less frequent in group A than in g roup B. Our data suggest that the ''La Pitie'' protocol provides a bet ter control of bleeding than the conventional heparin infusion in pati ents receiving assist device. this reduction in thrombo-hemorrhagic co mplications might improve the results of mechanical circulatory suppor t.