Task Force 4: Inpatient Management of Patients with MCSD - The ...

1. The MCS team should be made aware when an MCS patient is undergoing a NCP
so that collaboration between the MCS and surgical teams can take place.
Level of Evidence: C.
2. For non-emergent procedures, warfarin and antiplatelet therapy may be continued if
the risk of bleeding associated with the procedure is low. If therapy needs to be
stopped, warfarin and antiplatelet therapy should be held for an appropriate period of
time as determined by the type of procedure being undertaken and risk of bleeding.
Bridging with heparin or heparin-alternative while a patient is off warfarin may be
considered.
Level of Evidence: C.
3. For emergent procedures, warfarin may need to be rapidly reversed with FFP or
PCC. Vitamin K can be administered but has slower onset of action.
Level of Evidence: B.
4. Post-procedure, warfarin and antiplatelet therapy may be resumed when risk of
surgical bleeding is deemed acceptable. Patients may be bridged with heparin or
heparin alternative while waiting for the INR to reach the target range.
Level of Evidence: B
5. During minor procedures, blood pressure monitoring with Doppler is appropriate.
Level of Evidence: C.
6. During procedures with risk of hemodynamic instability, an arterial line should be
placed for blood pressure monitoring.
Level of Evidence: C.
7. A central venous catheter may be placed for monitoring of central venous pressure
and to administer drugs in the case of hemodynamic instability during surgical
procedures of moderate or high risk.
Level of Evidence: B.
8. During NCP, MCSD parameters should be continuously monitored by expert
personnel such as MCS nurses or perfusionists.
Level of Evidence: C.
9. A cardiovascular surgeon should be in the operating room or immediately available,
especially in situations when the NCP is in close proximity to the MCSD itself.
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