An Alternative Treatment Strategy for Pump Thrombus in the DeBakey VAD Child: Use of Clopidogrel as a Thrombolytic Agent

Studer, Matthew; Kennedy, Curtis; Dreyer, William J.; Price, Jack F.; Moffett, Brady S.; Teitel, Edward R.; Carberry, Kathleen E.; Morales, David L.S.; McKenzie, E. Dean; Chang, Anthony

doi:10.1016/j.healun.2006.03.013

Cited by 15 publications

(10 citation statements)

References 10 publications

(11 reference statements)

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“…621 Studies of these devices in infants and children are mainly retrospective case series with outcomes being survival to transplant or to cardiac recovery. 622,[626][627][628][629][630][631][632][633][634][635][636][637][638][639][640][641][642] Reported survival to transplant or to cardiac recovery ranges from 50% 630 to 83%. 628 There are no goodquality studies evaluating the safety and effi cacy of anticoagulant or antiplatelet therapy in children on VAD support to reduce TE.…”

Section: Primary Pulmonary Hypertensionmentioning

confidence: 99%

Antithrombotic Therapy in Neonates and Children

Monagle

Chan

Goldenberg

et al. 2012

Chest

1,269

559

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Section: Primary Pulmonary Hypertensionmentioning

confidence: 99%

Antithrombotic Therapy in Neonates and Children

Monagle

Chan

Goldenberg

et al. 2012

Chest

1,269

559

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“…We performed a comprehensive literature search using PubMed, to identify case reports [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] that relate to thrombus management in patients with continuous flow LVADs. Keywords used for the search included left ventricular assist devices, thrombosis, thrombolytic, Heart Mate II and Heart ware.…”

Section: IIImentioning

confidence: 99%

Successful Treatment of a Heart mate II Left Ventricular Assist Device Thrombus in the Setting of a Massive Acute Stroke: A Case Report and Review of the Literature

Srivastava¹

2014

JCCR

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A 56-year-old Caucasian male with a cardiac history of severe nonischemic cardiomyopathy, 3 months post Heart Mate II (Thoratec, Pleasanton, CA) Left ventricular Assist Device (LVAD) implantation, presented to the hospital with a history of acute difficulty in breathing, lethargy and decreased mentation per his wife. He was transferred from an outside hospital about 5 hours since presenting there and during which time he was treated for acute heart failure with intra-venous furosemide. On examination, he was found to be in severe respiratory distress and semi-obtunded. On physical exam he had significant right hemiplegia that was not reported from the outside hospital. A "Stroke Code" was called and a stat-non-contrast-enhanced CT brain was ordered. On connecting his LVAD to the base power module, his parameters were: RPM 10,000, Power-12, Pulsatility Index-2.1, and Flow-3-4 L/min, ( Table 1). The higher power and low PI readings in the setting of acute heart failureimmediately raised the suspicion of an acute device thrombus. His wife told us that patient's symptoms of shortness of breath, dizziness and an episode of fall with no loss of consciousness had started about 4 hours prior to presentation at the outside hospital and about 9 hours prior to presentation at our hospital.His past medical history was significant for episodes of gastrointestinal bleeds secondary to small bowel AV fistulas, Vital signs on presentation at the outside hospital were: Temperature 38.1 F, Heart Rate of 90-101 beats/minute, Respiratory Rate 20-40 breaths/ minute, mean arterial pressure of 70 mmHg and oxygen saturation of 94% on VentiMask 40%. On examination at our hospital he was found to be tachypneic at 33 breaths/minute requiring Bi-level positive airway pressure (BiPAP), heart rate-106 beats/minute, mean arterial pressure-64 mmHg and oxygen saturation of 90% on VentiMask 40%. He appeared confused and lethargic. Neck exam was positive for jugular venous distension. He had decreased breath sounds bilaterally and the LVAD hum was heard on cardiac exam. On neurologic exam, he did not follow any commands, was AbstractLeft ventricular assist devices (LVADs) are increasingly used to treat patients with advanced heart failure both as a Bridge-To-Cardiac Transplantation and Destination Therapy. Device thrombosis is a well-known complication of LVADs that can be potentially catastrophic if not diagnosed early and appropriately managed. We present a case of successful treatment of a suspected Heart Mate II thrombus with systemic thrombolysis and Eptifibatide in a patient who presented with signs and symptoms of acute decompensated heart failure and an ischemic stroke. We further compiled published case reports on acute thrombosis management in contemporary continuous flow LVADs, to discern various treatment approaches available for this serious complication. Published research on optimal anti-coagulation management strategy in the setting of acute device thrombosis is limited, primarily due to the size of this cohort but also due to the ...

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“…Frank pump thrombosis, leading to insufficient hemodynamic support and requiring a pump change, is not frequent, 24 but the formation of small thrombi that create turbulent flow and result in elevated lactate dehydrogenase and plasma‐free hemoglobin levels due to intravascular hemolysis is not infrequent. Infusion of intravenous heparin along with an additional anti‐platelet agent such as clopidogrel or a platelet glycoprotein IIb/IIIa receptor inhibitor has been shown to be helpful 25 , 26 . The application of thrombolytic agents such as recombinant tissue plasminogen activator has been reported to be effective in dissolving clots 27 , 28 …”

Section: Hematological Disturbance In Cfpsmentioning

confidence: 99%

“…Infusion of intravenous heparin along with an additional anti-platelet agent such review as clopidogrel or a platelet glycoprotein IIb/IIIa receptor inhibitor has been shown to be helpful. 25,26 The application of thrombolytic agents such as recombinant tissue plasminogen activator has been reported to be effective in dissolving clots. 27,28…”

Section: Hematological Disturbance In Cfpsmentioning

confidence: 99%

State-of-the-Art Implantable Cardiac Assist Device Therapy for Heart Failure: Bridge to Transplant and Destination Therapy

Park

Kushwaha

McGregor

2011

Clin Pharmacol Ther

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Congestive heart failure is associated with poor quality of life (QoL) and low survival rates. The development of state-of-the-art cardiac devices holds promise for improved therapy in patients with heart failure. The field of implantable cardiac assist devices is changing rapidly with the emergence of continuous-flow pumps (CFPs). The important developments in this field, including pertinent clinical trials, registry reports, innovative research, and potential future directions are discussed in this paper.

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An Alternative Treatment Strategy for Pump Thrombus in the DeBakey VAD Child: Use of Clopidogrel as a Thrombolytic Agent

Cited by 15 publications

References 10 publications

Antithrombotic Therapy in Neonates and Children

Antithrombotic Therapy in Neonates and Children

Successful Treatment of a Heart mate II Left Ventricular Assist Device Thrombus in the Setting of a Massive Acute Stroke: A Case Report and Review of the Literature

State-of-the-Art Implantable Cardiac Assist Device Therapy for Heart Failure: Bridge to Transplant and Destination Therapy

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