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Anticoagulation Strategies for Patients on Mechanical Circulation Support 

Anticoagulation Strategies for Patients on Mechanical Circulation Support
Chapter:
Anticoagulation Strategies for Patients on Mechanical Circulation Support
Author(s):

Scott D. Nei

DOI:
10.1093/med/9780190909291.003.0032
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date: 30 May 2020

Anticoagulation strategies for patients with mechanical circulatory support devices (MCSD) remain a daily challenge for clinicians. The balance between thrombosis and bleeding is delicate, with either extreme affecting patient morbidity and mortality. This chapter reviews the evidence for various anticoagulation strategies for patients with left ventricular assist devices (LVAD), extracorporeal membrane oxygenation (ECMO), and total artificial hearts (TAH). Clinical controversies related to tailoring anticoagulation strategies to individual patients addressed in this chapter include adjusting anticoagulation for gastrointestinal bleeding in patients with VADs and monitoring warfarin treatment with chromogenic factor X and with time in the therapeutic range. The direct use of thrombin inhibitors as primary anticoagulation for ECMO and the future of anticoagulation for MCSDs should help prepare clinicians for new research and changes in the field.

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