Instructions for use: Ikus - Berlin Heart

Postoperative platelet aggregation inhibition therapy
Note
• Many types of baby food contain high doses of vitamin K.
• The accuracy of the INR measurement of a laboratory varies by 0.2; between different
laboratories, it varies by up to +/-0.7.
If the INR value does not stabilize, then instead of heparin and/or a vitamin K
antagonist, low molecular weight heparin (Depending on the INR, ACT or PTT, start
administration of LMW heparin with an initial dose of 1mg/kg/2xd (every 12 h; applies
for enoxaparin ® ). The target dose varies according to the preparation used. Every
6 to 8 h after administration of LMW heparin, antifactor Xa (therapeutic range 0.6 to
0.8 U/ml) is checked.
9.1.3 Monitoring the blood values
The following blood values are monitored daily during the first week postoperatively:
• Antithrombin III level (target value > 75%)
• Fibrinogen
• D-dimers
• Leukocytes
• CRP
Note
• Every infection activates the coagulation system. Therefore, careful and regular
monitoring of the blood values is essential. If necessary, appropriate corrective action
should be taken immediately.
• Antithrombin is often reduced in infants and must be substituted accordingly.
9.2 Postoperative platelet aggregation inhibition therapy
The dose of the platelet aggregation inhibition substances acetylsalicylic acid and
dipyridamol should be adjusted on an individual basis. This can be monitored by means
of thrombocyte mapping or a platelet aggregation test. Since individual patients react
differently to platelet aggregation inhibition substances, the optimal dose should
minimize the risk of occurrence of thrombo-embolic complications (in the case of
underdose) or bleeding complications (in the case of overdose).
Start of therapy
• After removing all drainage shunts
• No earlier than days 2-4 postoperatively
• If the thrombocyte count is >100,000/μl
Monitoring frequency
• Week 1 postoperatively: 1x daily
• Week 2 postoperatively: every two days
• Week 3 postoperatively: 2x per week
• Subsequently: 1x per week
Note
• Some medications used to treat cardiac insufficiency have a positive effect on
anticoagulation and in particular on platelet aggregation inhibition. We recommend:
• Beta blockers
• ACE inhibitors
• Psychotropics such as serotonin reuptake inhibitors
• Inflammation parameters in patients with VAD oftentimes exceed the normal
thresholds. Omega-3 fatty acids have an anti-inflammatory effect (DHA, EPA; 3g/d) and
also lead to resistance of the thrombocyte membrane against premature activation.
• Antioxidants also have an anti-inflammatory effect.
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