• Am J Emerg Med · Mar 2021

    Case Reports

    Thromboelastometry-guided anticoagulation reversal in a patient with ventricular assist device with intracranial hemorrhage.

    • Veronica A Bonderski, Josue Portillo, Lydia Sharp, and Megan A Rech.
    • Department of Pharmacy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, United States. Electronic address: veronica.bonderski@luhs.org.
    • Am J Emerg Med. 2021 Mar 1; 41: 265.e5-265.e8.

    AbstractIntracranial hemorrhage (ICH) is a known complication in patients with ventricular assist devices (VAD). We present a case of a 42-year-old male with a VAD and on warfarin who presented to the emergency department with ICH necessitating anticoagulant reversal. An attenuated dose of 15 units/kg of 4-factor prothrombin complex-concentrates (4F-PCC) was given and the patient's coagulation profile was subsequently assessed using rotational thromboelastometry (ROTEM®) to determine appropriateness of reversal. ROTEM® analysis showed adequate reversal at the time of assessment and the patient ultimately returned home without further functional deficits, highlighting the role of ROTEM® to guide anticoagulation reversal in the VAD patient population.Copyright © 2020. Published by Elsevier Inc.

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