HeartWare Anticoagulation

Question 0

LT Anticoagulation

Answer 0

ASA 325mg/day within 24 hrs of implant if no bleeding complications

Warfarin target INR 2.0-3.0
Should be started within 4 days post-op

Question 1

Post-Op Day 1 Anticoagulation

Answer 1

Begin low-dose heparin @10 units/kg/hr to target PTT of 40-50 secs.
Chest drainage should be <40ml/hr for 3hrs
HCT stable w/o blood products
Gradually increase heparin to PTT 50-60 secs.

Question 2

Warfarin discontinued due to procedure dentist etc

Answer 2

Assessment of need to bridge w/heparin

Pts fall into “high risk” category for TE like mech. valve, Afib, etc and same considerations for bridging applied

Question 3

2006 ACC/AHA guidelines for bridging high risk pts for Cath

Answer 3

• Warfarin stopped approx. 48-72 hrs prior
• Heparin started when INR <2.0
• Heparin & Warfarin should be restarted post-procedure.
• Heparin is discontinued when therapeutic INR reached

Guidelines favor IV Heparin over low molecular weight heparin(LMWH)

FOR SURGERY-stop Warfarin 5 days pre-op & bridge