Management Of Pump Thrombosis Research Articles

Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices.

Left ventricular assist device (LVAD) implantation as destination therapy (DT) is a valuable treatment option in patients with end-stage heart failure ineligible for heart transplant. However, this therapy can be complicated by life-threatening pump thrombosis (PT). This case series reports our single-center experience with a structured systemic thrombolysis protocol in case of PT. Consecutive patients undergoing DT LVAD (HVAD, Medtronic, Framingham, MA) implantation between 2010 and April 2021 at our institution were reviewed and those with PT identified. Clinical, laboratory and LVAD specific data were collected and analyzed retrospectively. All patients with PT were treated with systemic thrombolysis according to a structured bedside protocol. Treatment was defined successful if a patient was alive at 30 days follow-up and free of recurrent PT, stroke or device exchange. Fourteen out of 94 patients experienced a PT after LVAD implantation (11%). Systemic thrombolysis was successful in 10 of 14 patients (71%) at 30 days. Two patients died within 30 days due to a hemothorax and multi-organ failure. In three patients treatment was complicated by a major bleeding; twice a hemothorax (one fatal) and one right calf bleeding. No intracerebral hemorrhage was observed. Three patients experienced a thrombotic complication within 30 days; all recurrent PT. Eleven of the 14 DT patients were discharged home after a limited hospital stay after thrombolysis (average of 11 days). In conclusion, systemic thrombolysis may be a reasonable option for life-threatening PT in this vulnerable DT group in whom device exchange is often impossible due to comorbidity.

(648) - Diagnosis and Management of Pump Thrombosis in Patients with Continuous-Flow Ventricular Assist Devices

(648) - Diagnosis and Management of Pump Thrombosis in Patients with Continuous-Flow Ventricular Assist Devices

Medication management for left ventricular assist device thrombosis.

Current strategies for prevention and treatment of "pump thrombosis" associated with the use of left ventricular assist devices (LVADs) are discussed. LVADs provide morbidity, mortality, and quality-of-life benefits in patients with advanced heart failure. Since continuous-flow LVADs came into wide use, there have been increased reports of pump thrombosis (clot formation in the LVAD system that can lead to pump dysfunction and clinical complications). Anticoagulation and antiplatelet therapies are important for preventing pump thrombosis, although the optimal antithrombotic regimen remains unclear. International Normalized Ratio goals should be determined according to specific device characteristics and patient risk factors. Medication therapy for pump thrombosis provides a less invasive option than surgical pump exchange or heart transplantation but is associated with high risks of bleeding events, recurrent pump thrombosis, and mortality. Decisions regarding medical versus surgical management should be based on clinical status and surgical candidacy. Management of pump thrombosis may include intensified i.v. anticoagulation, i.v. or intraventricular thrombolytics, or glycoprotein IIb/IIIa inhibitors. Optimization and close monitoring of anticoagulation and antiplatelet therapy can help reduce the risk of pump thrombosis. Intensive clinical and laboratory monitoring are important in identifying signs and symptoms of LVAD thrombosis. Medical management of LVAD thrombosis can be considered an early treatment strategy before thrombi become too large and unresponsive to pharmacotherapies, but antithrombotic medications carry a high risk of bleeding complications and should be used judiciously. More definitive treatment with pump exchange or heart transplantation in appropriate candidates may be required.

Management of pump thrombosis in patients with left ventricular assist devices.

The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.

Continuous heart ware LVAD thrombosis: Pro-pump change

Aims: The HeartWare VAD, third-generation implantable VAD, includes an axial pump integrated into the device. Despite its advantages, the rate of thrombus formation and of thrombo-embolic events are not negligible. The therapeutic options are few; thrombolytic therapy with the risks of recurrence and bleeding, and surgical device exchange associating with the problems of an urgent redo procedure. Actually, there is no recommendation concerning the management of pump thrombosis. The aim of the study was to report the Bad Oeynhausen experience concerning the management of LVAD HeartWare thrombus. We related 7 cases of HeartWare thrombosis which were treated by the two strategy systemic thrombolysis and pump exchange.