Direct Thrombolytic Therapy for Thrombosis of a Centrifugal Flow Left Ventricular Assist Device

Jabbar, Ali Abdul; Yau, Raymond; Frazier, O.H.; Delgado, Reynolds M.

doi:10.1097/mat.0b013e3182a39628

Cited by 16 publications

(10 citation statements)

References 8 publications

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“…Four very similar case reports were published that all used similar strategies of intraventricular alteplase administration. All were successful, with similar dosing regimens of 1 mg/minute for varying times (20–37 min) until thrombus resolution, and pump parameter and hemodynamic improvements were directly observed . The patient from one of the case reports required two consecutive fibrinolytic sessions to achieve complete resolution of thrombus but was still managed successfully with this technique .…”

Section: Pharmacotherapy Of Device‐related Thrombosismentioning

confidence: 94%

Thrombosis in Continuous-Flow Left Ventricular Assist Devices: Pathophysiology, Prevention, and Pharmacologic Management

Jennings

Weeks

2014

Pharmacotherapy

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Continuous-flow left ventricular assist devices reduce short-term mortality and improve quality of life in patients with end-stage heart failure. Unfortunately, device-related complications remain common, with many patients experiencing adverse events within the first year. New literature suggests that rates of device-related thrombosis may be increasing since 2011, which is particularly troublesome given that this pathology can result in a disabling stroke, organ damage, and death. In 2013, a group of practitioners in the field of mechanical circulatory support published a treatment algorithm based on their expert opinion. However, a comprehensive review of the pharmacotherapy of this condition is lacking. A search of the literature revealed 20 separate publications of case reports or case series describing outcomes associated with the use of drug therapy for suspected pump thrombosis. Each of these experiences was limited by small sample size, nonrandomized treatment allocation, and nonstandardized medication dosing. Data describing the outcomes of surgical versus medical management of device thrombosis are also sparse, with only three published reports identified. Based on the review of this limited literature, surgical management appears to be the preferred treatment modality, especially in those with organ hypoperfusion or hemodynamic instability. In patients ineligible for surgery, pharmacotherapy options remain limited. Use of all drug classes described in the literature for the HeartMate II device-fibrinolytics, glycoprotein IIb/IIIa inhibitors, and direct thrombin inhibitors-was hindered by either marginal efficacy or bleeding. Based on historical experience with unfractionated heparin in patients under HeartMate II support, we recommend this agent as a possible option for those with suspected pump thrombosis in lieu of surgical device exchange. For the HeartWare HVAD, limited data suggest that direct intraventricular administration of alteplase may be an acceptable treatment alternative. Additional research is clearly needed to further delineate the role of pharmacotherapy and to identify the optimal agent for managing this potentially life-threatening condition.

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Section: Pharmacotherapy Of Device‐related Thrombosismentioning

confidence: 94%

Thrombosis in Continuous-Flow Left Ventricular Assist Devices: Pathophysiology, Prevention, and Pharmacologic Management

Jennings

Weeks

2014

Pharmacotherapy

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“…In clinical studies, almost no pump thrombosis was found inside these maglev ventricular assist pumps. 22–25 Other than pump thrombosis, there were no significant differences between the HeartMate II axial blood pump and the Heartmate III maglev centrifugal pump with regard to the associated rates of other major complications, such as right heart failure, stroke, major infection, or gastrointestinal bleeding. 23 However, this lack of difference does not mean that there is no pump thrombosis in maglev pumps.…”

Section: Discussionmentioning

confidence: 98%

Numerical investigation of the influence of a bearing/shaft structure in an axial blood pump on the potential for device thrombosis

et al. 2019

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Adverse events caused by flow-induced thrombus formation around the bearing/shaft of an axial blood pump remain a serious problem for axial blood pumps. Moreover, excessive anticoagulation with thrombosis around the bearing potentially increases the risk of postoperative gastrointestinal bleeding. The purpose of this study is to analyze the influence of the bearing structure on the thrombosis potential of an axial blood pump. The bearing/shaft structure was embedded into an axial blood pump numerical model. The numerical simulation and analysis are focused on the low wall shear stresses, recirculation, and residence time close to the bearing region to evaluate the potential for thrombosis around the bearing. Then, the flow field near the blood pump bearing was tested via in vitro particle image velocimetry experiments to verify the numerical results. The simulation results showed that after embedding the bearing/shaft structure a recirculation zone appeared in the outlet guide vane bearing/shaft region, the residence time increased 11-fold in comparison to the pump without the bearing/shaft structure, the scalar shear stress in the shaft surface was less than 7.8 Pa, and the stress accumulation was less than 0.10 Pa s. The numerical results showed that platelets that flow through the bearing region are exposed to significantly lower wall shear stress and a longer residence time, leading to activated platelet adhesion. The reduced stress accumulation and increased time in the bearing region lead to increased platelet activation.

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“…Several other studies reported on thrombolytic therapy of pump thrombosis. 7,[14][15][16] Schlendorf et al reported on eight patients who underwent intraventricular application of thrombolytics (1 mg/min over 30 min) with a 38% success rate. 16 The Evaluation of the HeartWare Left Ventricular Assist Device for the Treatment of Advanced Heart Failure (ADVANCE) trial reported on 31 patients with HVAD pump thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Effective treatment with a new protocol using tissue-type plasminogen activator thrombolysis for pump thrombosis with the HVAD device

Schrage

Grahn

Wagner

et al. 2017

European Heart Journal: Acute Cardiovascular Care

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Direct Thrombolytic Therapy for Thrombosis of a Centrifugal Flow Left Ventricular Assist Device

Cited by 16 publications

References 8 publications

Thrombosis in Continuous-Flow Left Ventricular Assist Devices: Pathophysiology, Prevention, and Pharmacologic Management

Thrombosis in Continuous-Flow Left Ventricular Assist Devices: Pathophysiology, Prevention, and Pharmacologic Management

Numerical investigation of the influence of a bearing/shaft structure in an axial blood pump on the potential for device thrombosis

Effective treatment with a new protocol using tissue-type plasminogen activator thrombolysis for pump thrombosis with the HVAD device

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