Thrombin-antithrombin complex might be a promising parameter for monitoring anticoagulation in the early postoperative period after LVAD implantation

Abstract 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 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.