(160) Therapeutic ACT Values Associated With an Automatic Pharmacist Consult for Impella Anticoagulation

Introduction: The Impella® is a percutaneous left ventricular assist device used in patients with refractory cardiogenic shock. Anticoagulation practices utilized to prevent device complications vary greatly. At the present institution, an automatic pharmacist consult process was developed to oversee appropriate initiation and management of anticoagulation in patients with an Impella® device. The purpose of this study was to evaluate the effectiveness of an automatic pharmacist consult process for achieving therapeutic anticoagulation in patients with an Impella® device.

Methods: This was a retrospective, single-center cohort study of adult patients who received heparin-based purge solution after placement of an Impella® device for cardiogenic shock. The intervention was implementation of an automatic pharmacist consult process to manage anticoagulation. Prior to this consult process, there was no institutional protocol, and anticoagulation was managed on an individual basis by the attending provider. The intervention group had Impella® device placement between August 2021 and August 2022, after the implementation of an automatic pharmacist consult process. The control group had placement between April 2014 and July 2021 prior to pharmacist consult implementation. The primary endpoint was the percentage of ACT values that were therapeutic within a goal ACT of 160-180 seconds. Secondary endpoints included in-hospital mortality, thromboembolic events, hemolysis, major bleeding and non-major bleeding, purge-gap occlusion, and adherence to institutional process.

Results: There were 65 patients identified for inclusion after screening for exclusion criteria. This included 41 patients in the pre-implementation group and 24 patients post-implementation. A total of 961 ACT values were obtained during the study period. Among the post-implementation group, 41.1% of ACT values were therapeutic, compared with 35.2% in the pre-implementation group (p=0.039). There were no statistically significant differences detected among secondary outcomes.

Conclusions: Among patients with an Impella® device for cardiogenic shock receiving anticoagulation with a heparin-based purge solution, an automatic pharmacist consult process was associated with a significant increase in percentage of therapeutic ACT values.