For a patient following drug-eluting stent placement who is in shock and receiving TandemHeart support, what is the most appropriate recommendation regarding anticoagulation?

For a patient who has undergone drug-eluting stent placement and is receiving TandemHeart mechanical support while in shock, the recommendation to add a specific dose of unfractionated heparin to the device infusate with a goal activated partial thromboplastin time (aPTT) of 65-80 seconds is the most appropriate.

This approach is crucial because the TandemHeart device is designed to provide significant hemodynamic support in cases of cardiogenic shock, and maintaining effective anticoagulation is vital to prevent thrombus formation on the device, which can lead to serious complications such as device malfunction or embolism.

Using unfractionated heparin allows for precise monitoring and adjustments of anticoagulation therapy based on the patient's response, as the aPTT can be closely tracked. The target aPTT level of 65-80 seconds is often established based on clinical guidelines to ensure adequate anticoagulation without increasing the risk of bleeding. The addition of the heparin to the device infusate is particularly advantageous as it ensures the anticoagulant is distributed effectively within the circulatory system supporting the mechanical device.

Other anticoagulation strategies, such as initiating enoxaparin or considering argatroban, may