AI Article Synopsis
- A 38-year-old man with heart failure was treated with heparin and other anticoagulants while on a Berlin Heart device for 19 days.
- Despite following APTT guidelines, tests showed increased clot firmness and fibrin strength, indicating hypercoagulability.
- No thrombosis symptoms were observed, and coagulation levels normalized after heart transplantation, suggesting APTT may not be reliable for monitoring during mechanical cardiac support.
Article Abstract
We report hypercoagulability despite activated partial thromboplastin time (APTT)-guided heparin treatment during Berlin Heart-supported circulation in a 38-year-old man with heart failure for 19 days. The patient was anticoagulated using unfractionated heparin, acetylsalicylic acid and dipyridamole. Contact and tissue factor-activated thromboelastometry revealed increased clot firmness, although anticoagulation assessed by APTT was in accordance with the treatment protocol. Strength of polymerized fibrin was also increased. We saw no clinical signs of thrombosis. Thromboelastometry normalized after heart transplantation. Our results suggest that hypercoagulability is due to excess fibrin formation. Monitoring anticoagulation using APTT may, therefore, be misleading during mechanical cardiac assist.
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| http://dx.doi.org/10.1177/0267659108094738 | DOI Listing |
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