{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T05:04:42Z","timestamp":1777784682085,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T00:00:00Z","timestamp":1754179200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Artif Organs"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      The combination of VA-ECMO and Impella\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , known as \u201cECpella\u201d offers an alternative to the method of left ventricle unloading with intra-aortic balloon pump (IABP). Limited information is available to inform anticoagulation management in cases of concomitant use of Mechanical Circulatory Support (MCS) devices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective study included 34 patients receiving hemodynamic support through concomitant MCS for cardiogenic shock for a duration exceeding 24\u2009h. Data collection included patients\u2019 demographics, comorbidities, transfusion requirements, anticoagulation protocol, time within therapeutic anticoagulation range, and incidence of bleeding or ischemic events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Survival to discharge was 32.4% (11 out of 34). Of the 34 patients, 28 patients were treated with a combination of VA-ECMO and IABP (82.4%), while 6 patients (17.6%) were supported with the ECpella. Patients in the VA-ECMO with IABP group had a longer hospital stay (median\u2009=\u200930\u2009days, IQR\u2009=\u200920\u201343.5) when compared to the ECpella group (median\u2009=\u200921.5\u2009days, IQR\u2009=\u20096\u201363). Bleeding was documented in a similar proportion in both arms of the investigation (89% in the VA-ECMO with IABP group and 83% in the ECpella group). Thrombosis was more common in the VA-ECMO with IABP group (17.9%) as compared to the ECpella group (16.7%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Cardiogenic shock requiring concomitant MCS which includes VA-ECMO presents a challenging clinical scenario where the risks of bleeding and thrombosis have to be balanced. Our experience, and review of the literature, highlight the need for further investigation via large retrospective registry analysis as well as randomized controlled trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03913988251359952","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T06:06:41Z","timestamp":1754287601000},"page":"686-697","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anticoagulation in the setting of concomitant temporary mechanical circulatory support: Experience from a quaternary care center in the Middle East and review of the literature"],"prefix":"10.1177","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4775-3858","authenticated-orcid":false,"given":"Omar","family":"El Khatib","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Hisham","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE"},{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salma","family":"Al Shaqfa","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussam H","family":"Ghalib","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, Al Maryah Island, Abu Dhabi, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shreya","family":"Pai","sequence":"additional","affiliation":[{"name":"College of Medicine, RCSI Bahrain, Adliya, Bahrain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iyad","family":"Ghazal","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Gulf Medical University, Ajman, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bassam","family":"Atallah","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Dubai Medical University, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,8,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.034512"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.11.103"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001652"},{"key":"e_1_3_2_5_2","unstructured":"Vyas A Bishop MA. 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