125Patient Management and Education
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Appendix
Reference
Guides
Alarms and
Emergencies
Patient
Management
Surgical
Implant and
Explant
Monitor
Peripherals
and
Accessories
HVAD
®
PumpOverviewIntroduction
7.1 Postoperative Management (continued)
7.1.2 Blood Pressure Maintenance
Similar to the ISHLT Recommendations, monitoring of blood pressure following HVAD implant has
shown to be very important to optimize patient results, in particular to minimize risk of stroke.
Since the HVAD
®
pulse pressure, it is best to monitor the mean arterial pressure (MAP).
Blood pressure should be monitored during both the immediate post-operative period as well as
for the duration of support. To monitor blood pressure after the removal of the invasive arterial
line utilize either an automated cuff or doppler method.
Blood pressure management goals should be individualized to the patient conditions. The
following are recommended bloodpressure management practices:
Prior to discharge, patients and/or caregivers should be trained to obtain blood pressure
readings and record values.
For patients with a palpable pulse, a manual cuff and a doppler is the preferred method
intervention as part of their discharge instructions.
7.1.3 Anticoagulation
Prior to HVAD
®
Pump implantation, many patients with refractory heart failure have abnormal
should be performed prior to HVAD
®
Pump implantation. The return of each of these parameters
to a normal range prior to HVAD
®
Pump implantation is an important goal.
Anticoagulation should be individualized for each patient. In general, begin low-dose heparin
at 10 units/kg/hr on postoperative day one to a target PTT of 40-50 seconds. Prior to initiation of
anticoagulation, chest tube drainage should be less than 40 ml/hr for approximately three hours;
the HCT should be stable without the need for transfusion of blood products, and coagulation
factors approaching normal. Gradually increase the heparin dosage to maintain the aPTT in a
range of 50-60 seconds.
The recommended long term oral anticoagulation regimen for the HVAD
®
Pump is a
combination of warfarin and aspirin. In general, aspirin should be started at a dose such as
325 mg/day within 24 hours after implant if there are no postoperative bleeding complications.
However, if ASA alone is the medication chosen for anti-platelet therapy, a check for ASA
®
) is recommended to establish the dose or to
select an alternative medication. Multi-drug options include:
ASA 81 mg plus Aggrenox
®
(ASA (25 mg) plus extended –release dipyridamole (200 mg))
ASA 81 mg plus clopidogrel 75 mg daily
For patients who are aspirin sensitive or otherwise intolerant, clopidogrel at doses of 75-150 mg/
day is a viable alternative. A clopidogrel loading dose of 300 mg followed by 75 mg/day is
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