Optimizing Anticoagulation Therapy when Utilizing Mechanical Circulatory Support Devices.

Hemorrhagic complications are frequent and clinically significant in patients undergoing mechanical circulatory support (MCS), occurring in 10% to 40% of cardiogenic shock cases and 5% to 10% of high-risk percutaneous coronary interventions. These events prolong hospitalization, increase morbidity, and adversely impact outcomes. This review examines the prevention and management of bleeding during MCS implantation, prolonged support, and removal. Access-site complications-predominantly from large-bore sheaths-can be mitigated through pre-procedural vascular imaging, ultrasound-guided puncture, and proficiency with large-bore closure techniques. During prolonged support, systemic bleeding may result from device-related hemocompatibility issues, combined antithrombotic therapy, and acquired coagulopathies.