(365) A Comparison of Anticoagulation Strategies in Patients With Intra-Aortic Balloon Pumps

Introduction: Intra-aortic balloon pumps (IABPs) are mechanical support devices used in patients with cardiac dysfunction as a bridge to either symptom improvement or permanent intervention. These pumps have been associated with a higher risk of thrombotic events, and it has become common practice to start these patients on systemic anticoagulation. Literature on the safety and efficacy of anticoagulation in this patient population is limited, and there are currently no guideline recommendations on the proper management of these patients. The purpose of this study was to determine if there is a difference in thrombotic and bleeding complications between patients with an IABP receiving therapeutic anticoagulation versus those not receiving therapeutic anticoagulation.

Methods: This was a single center, retrospective, observational cohort study. Adult patients with an IABP placed at Rush University Medical Center from January 2019 through September 2022 and maintained on support for at least 48 hours were included. Patients placed on extracorporeal membrane oxygenation, pregnant women, and those with separate indications for anticoagulation or baseline coagulopathy were excluded. The primary outcome was the incidence of thrombotic events in patients who received therapeutic anticoagulation compared with those who did not. Secondary outcomes included the incidence of bleeding, hospital and intensive care unit (ICU) length of stay, and in-hospital and 28-day mortality.

Results: A total of 28 patients were included in this study, 19 of which received therapeutic anticoagulation. There was no significant difference in the incidence of thrombotic events between the heparin and non-heparin groups [4 (21.1%) and 2 (22.2%), p = 1.00]. Similarly, both groups saw 2 bleeding events (10.5% of the heparin group and 22.2% of the non-heparin group, p = 0.57), and there were no significant differences in ICU or hospital length of stay, or in-hospital or 28-day mortality.

Conclusions: Systemic anticoagulation did not significantly lower the incidence of thrombotic events or significantly increase the risk of bleeding. Further research is needed to clarify clinical scenarios where IABP patients would require anticoagulation as current data indicates that IABP placement alone may not warrant therapeutic anticoagulation.