Case Study: Measuring TAT Complex in LVAD Implantation

Introduction: Appropriate bridging anticoagulation is critical in the early postoperative period after left ventricular assist device (LVAD) implantation, because the patients are usually in a fragile balance of thrombotic to bleeding risk. Unfortunately, the ideal manner of monitoring postoperative bridging anticoagulation remains undetermined.

Methods: Here we reported a case demonstrating that the thrombin-antithrombin complex might be an option in this situation.

Results: This patient suffered thrombosis and bleeding simultaneously within 7 days after implantation, and the 2 commonly used methods for monitoring bridging anticoagulation, activated partial thromboplastin time and anti-Xa activity, were incompatible with each other. After a multi-disciplinary team discussion, the clinicians decided to manage his anticoagulation based on thrombin-antithrombin complex level. It worked out well, and the patient was transferred to a general ward 2 weeks later.

Discussion: With respect to clinical endpoints, thrombin-antithrombin complex might be a promising parameter for monitoring anticoagulation in the early postoperative period after LVAD implantation.