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Thrombolytic therapy for thrombosis of continuous flow ventricular assist devices.

Publication ,  Journal Article
Schlendorf, K; Patel, CB; Gehrig, T; Kiefer, TL; Felker, GM; Hernandez, AF; Blue, LJ; Milano, CA; Rogers, JG
Published in: J Card Fail
February 2014

BACKGROUND: Despite chronic systemic anticoagulation, advanced heart failure patients treated with a continuous-flow left ventricular assist device (LVAD) remain at risk for pump thrombosis. Pump thrombosis may initially be suspected in the setting of clinical and biochemical evidence for intravascular hemolysis, putatively related to shear stress on red blood cells propelled through a partially occluded pump. Limited data exist to guide management in these patients. METHODS AND RESULTS: We present a series of 8 LVAD patients who presented with intravascular hemolysis secondary to pump thrombosis who were treated with intraventricular thrombolytic therapy. In 3 patients, thrombolytic therapy led to complete and lasting resolution of hemolysis, suggesting successful dissolution of pump thrombus. In the remaining 5 patients, thrombolytic therapy ultimately failed to halt or reverse pump thrombosis and hemolysis: 1 patient required emergent pump exchange, 2 patients progressed to cardiogenic shock and died, 1 patient suffered a debilitating stroke after which care was withdrawn, and 1 patient underwent cardiac transplantation. CONCLUSIONS: In the setting of LVAD thrombosis, thrombolytic therapy is an alternate treatment strategy in a subset of patients. Candidacy for this alternate procedure must carefully weigh the risks of complications, including hemorrhage and thromboembolism.

Duke Scholars

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

February 2014

Volume

20

Issue

2

Start / End Page

91 / 97

Location

United States

Related Subject Headings

  • Tissue Plasminogen Activator
  • Thrombosis
  • Thrombolytic Therapy
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Female
  • Cardiovascular System & Hematology
 

Citation

APA
Chicago
ICMJE
MLA
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Schlendorf, K., Patel, C. B., Gehrig, T., Kiefer, T. L., Felker, G. M., Hernandez, A. F., … Rogers, J. G. (2014). Thrombolytic therapy for thrombosis of continuous flow ventricular assist devices. J Card Fail, 20(2), 91–97. https://doi.org/10.1016/j.cardfail.2013.12.011
Schlendorf, Kelly, Chetan B. Patel, Thomas Gehrig, Todd L. Kiefer, G Michael Felker, Adrian F. Hernandez, Laura J. Blue, Carmelo A. Milano, and Joseph G. Rogers. “Thrombolytic therapy for thrombosis of continuous flow ventricular assist devices.J Card Fail 20, no. 2 (February 2014): 91–97. https://doi.org/10.1016/j.cardfail.2013.12.011.
Schlendorf K, Patel CB, Gehrig T, Kiefer TL, Felker GM, Hernandez AF, et al. Thrombolytic therapy for thrombosis of continuous flow ventricular assist devices. J Card Fail. 2014 Feb;20(2):91–7.
Schlendorf, Kelly, et al. “Thrombolytic therapy for thrombosis of continuous flow ventricular assist devices.J Card Fail, vol. 20, no. 2, Feb. 2014, pp. 91–97. Pubmed, doi:10.1016/j.cardfail.2013.12.011.
Schlendorf K, Patel CB, Gehrig T, Kiefer TL, Felker GM, Hernandez AF, Blue LJ, Milano CA, Rogers JG. Thrombolytic therapy for thrombosis of continuous flow ventricular assist devices. J Card Fail. 2014 Feb;20(2):91–97.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

February 2014

Volume

20

Issue

2

Start / End Page

91 / 97

Location

United States

Related Subject Headings

  • Tissue Plasminogen Activator
  • Thrombosis
  • Thrombolytic Therapy
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Heart-Assist Devices
  • Female
  • Cardiovascular System & Hematology