Mechanical Circulatory Support in critically ill cardiogenic shock patients: a complex process of Thrombosis and Hemostasis.

The success of mechanical circulatory support (MCS) has greatly
increased due to improved oxygenators, better design of the heart
pumps and certainly due to better medical management.
Nevertheless mortality of patients undergoing MCS remains high
(50%) and complications are frequent. Paradoxically, the most
common complications are both (life-threatening) bleeding (40-50%)
ánd thrombosis as recently confirmed in a large US-trial covering
more than 25.000 micro-axial flow pump supported cardiogenic
shock patients.
Although coagulopathy is the most important cause of
morbidity/mortality in MCS-patients, its management is still poorly
studied and anticoagulation management in critically ill MCS-patients
remains an open research field without answers to the most basic
questions: how should we monitor anticoagulants, which
anticoagulation target should we aim for and which anticoagulant to
use. This project aims to elucidate these important questions through
a strong international collaboration with various high-output MCScenters
and through experts in the field. We rely on research going
from the bench (ex vivo micro-axial flow pump loops, ex vivo platelet
research) to bed-side (confirmation of our retrospective study results
in a prospective, randomized study set-up).