Anticoagulation Strategies in Temporary Mechanical Circulatory Support

Purpose of reviewSystemic therapeutic anticoagulation is uniformly recommended to minimize thromboembolic risk in patients treated with mechanical circulatory support for cardiogenic shock. These patients remain at an elevated bleeding risk as a consequence of both vascular instrumentation and underlying multifactorial hematologic and coagulative derangements. Despite this, there is a void in guidance for appropriate strategies for mitigating thrombotic and bleeding risks.Recent findingsStudies have shown significant variability in the risk of thrombotic and bleeding complications in patients maintained on mechanical circulatory support.In this article,we review anticoagulation recommendations and approaches for various commonlyemployed mechanical circulatory devices. We additionally describe thefrequently utilized monitoring assays employed in the intensive care unit andhighlight the need for more comprehensive parameters of hemostasis in these systemicallyill patients.