{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T10:17:28Z","timestamp":1777544248890,"version":"3.51.4"},"reference-count":44,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,9,19]],"date-time":"2017-09-19T00:00:00Z","timestamp":1505779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:p>Percutaneous mechanical circulatory support (<jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content>) devices, including the intraaortic balloon pump, Impella, and TandemHeart, are often used for hemodynamic support in the setting of refractory cardiogenic shock. The thrombotic and bleeding complications associated with these devices is well recognized, and the Impella and TandemHeart devices have unique anticoagulation considerations that may influence patient outcomes. Both devices typically require use of a heparinized purge solution in combination with intravenous unfractionated heparin, thereby providing multiple sources of heparin exposure. Each device also has specific monitoring requirements and goal ranges. This review provides an overview of percutaneous <jats:styled-content style=\"fixed-case\">MCS<\/jats:styled-content> devices commonly used in the acute management of left ventricular failure, with an emphasis on pharmacologic considerations. We review recent evidence and guidelines and provide recommendations for appropriate use of anticoagulation during device support. Approaches to managing heparinized purge solutions, monitoring, and the utility of nonheparin anticoagulants are also provided because high\u2010quality evidence in the literature is limited.<\/jats:p>","DOI":"10.1002\/phar.1995","type":"journal-article","created":{"date-parts":[[2017,7,25]],"date-time":"2017-07-25T06:58:20Z","timestamp":1500965900000},"page":"1272-1283","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Pharmacologic Considerations in the Management of Patients Receiving Left Ventricular Percutaneous Mechanical Circulatory Support"],"prefix":"10.1002","volume":"37","author":[{"given":"J. Erin","family":"Allender","sequence":"first","affiliation":[{"name":"Department of Pharmacy WakeMed Health &amp; Hospitals Raleigh North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent N.","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Science University of Maryland School of Pharmacy Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenna L.","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Services Palmetto Health Richland Columbia South Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy D.","family":"Moretz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie S.","family":"Oliphant","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Methodist Healthcare\u2010University Hospital and University of Tennessee College of Pharmacy Memphis Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas L.","family":"Jennings","sequence":"additional","affiliation":[{"name":"Department of Pharmacy New York Presbyterian Columbia University Medical Center New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"DiDomenico","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice University of Illinois at Chicago Chicago Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7193-3751","authenticated-orcid":false,"given":"James C.","family":"Coons","sequence":"additional","affiliation":[{"name":"Department of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy and UPMC Presbyterian Hospital Pittsburgh Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,9,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25720"},{"key":"e_1_2_8_3_1","volume-title":"Harrison's principles of internal medicine","author":"Hochman JS","year":"2015"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.115.002359"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.019"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2016.03.003"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht248"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1208410"},{"key":"e_1_2_8_9_1","volume-title":"Impella ventricular support systems for use during cardiogenic shock","author":"Abiomed, Inc.","year":"2016"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.07.065"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.065"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2014.12.012"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.098194"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.022"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.026"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi161"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2006.05.031"},{"key":"e_1_2_8_18_1","volume-title":"TandemHeart guide to patient management","author":"CardiacAssist, Inc.","year":"2016"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1161\/hc4901.100361"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.08.613"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0b013e31819644b3"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.967224"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/joic.12080"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivs017"},{"key":"e_1_2_8_25_1","volume-title":"5% Dextrose with heparin as default Impella purge solution","author":"Abiomed, Inc","year":"2015"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028013503623"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.05.003"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.23465"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2016.10.023"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000000176"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000000244"},{"issue":"1373","key":"e_1_2_8_32_1","first-page":"e4","article-title":"Heparin\u2010induced thrombocytopenia in patients receiving mechanical circulatory support","volume":"131","author":"Schenk S","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2007.03.049"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp160212"},{"key":"e_1_2_8_35_1","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1051\/ject\/200840130","article-title":"Argatroban in short\u2010term percutaneous ventricular assist subsequent to heparin\u2010induced thrombocytopenia","volume":"40","author":"Webb DP","year":"2008","journal-title":"J Extra Corpor Technol"},{"key":"e_1_2_8_36_1","first-page":"E5","article-title":"First human case description of TandemHeart\u2010assisted high\u2010risk percutaneous balloon aortic valvuloplasty using bivalirudin anticoagulation","volume":"19","author":"Rajdev S","year":"2007","journal-title":"J Invasive Cardiol"},{"key":"e_1_2_8_37_1","first-page":"464135","article-title":"Impella induced massive hemolysis: reemphasizing echocardiographic guidance for correct placement","volume":"2015","author":"Cardozo S","year":"2015","journal-title":"Case Rep Cardiol"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2012.10.011"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000000290"},{"key":"e_1_2_8_40_1","unstructured":"The Joint Commission.2017 national patient safety goals. Available fromhttps:\/\/www.jointcommission.org\/standards_information\/npsgs.aspx. Accessed January 14 2017."},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1875-9114.2011.01049.x"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2014.08.022"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1R635"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1Q161"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.114.5_Supplement.489S"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1995","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.1995","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T12:19:12Z","timestamp":1761049152000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.1995"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,19]]},"references-count":44,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2017,10]]}},"alternative-id":["10.1002\/phar.1995"],"URL":"https:\/\/doi.org\/10.1002\/phar.1995","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,19]]},"assertion":[{"value":"2017-09-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}