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

Abstract

Our data indicates that using a uniform treatment protocol that builds on usage of tissue-type plasminogen activator thrombolysis might be an effective tool for treatment of continuous flow left ventricular assist device pump thrombosis in haemodynamically stable patients. Additionally, our data indicates that infection may be a potential trigger for pump thrombosis.

Analysis of Minimally Invasive Left Thoracotomy HVAD Implantation – A Single-Center Experience

“…The most common adverse events (►Table 3) were infections in 44 patients (62.9%) followed by bleeding (22 events), cardiac arrhythmia (14 events), and neurological events (14 events). In total, 16 pump thrombosis occurred in 10 patients (n ¼ 7 STX group, n ¼ 3 LT group); 7 of these patients received thrombolytic therapies as described by Schrage et al 12 Two patients had pump replacement and one patient was treated conservatively without thrombolytic therapy and pump exchange. The incidence of LVAD-related infections and wound dehiscences was lower in the LT group (4/0 events) compared with the STX group (20/5 events; p ¼ 0.06/0.17).…”

Outcomes following left ventricular assist device exchange

“…18 Instead, log file analysis and acoustic spectral analysis are often used with computerized tomography imaging to aid in the diagnosis of device thrombosis, 19 with tissue-plasminogen activator therapy most often used for treatment. 20 The exchange group tended to have higher survival compared to the non-exchange group (93% vs 76%, P = .15; Figure 4A). The readmission-free rates did not statistically differ between the two groups (48% vs 55%, P = .61; Figure 4B).…”

“…Also, echocardiographic ramp studies to assess for device thrombosis in patients with HVADs are not well validated . Instead, log file analysis and acoustic spectral analysis are often used with computerized tomography imaging to aid in the diagnosis of device thrombosis, with tissue‐plasminogen activator therapy most often used for treatment …”

Renal dysfunction and cardiogenic shock complicating acute coronary syndromes

“…Results from a small series indicate that in haemodynamically stable patients thrombolysis using tissue-type plasminogen activator might be an effective option for treatment of continuous flow left ventricular assist device pump thrombosis. 11 Further in this issue an intriguing case is reported in a young woman requiring veno-venous extracorporeal support for severe secondary respiratory failure who developed a myocardial ischaemia due to an intermittent obstruction of the right coronary sinus by a fluttering thrombus. 12 Portable telemetry monitoring has been used in intermediate or step-down units for the in-hospital detection of arrhythmias in a diverse group of medical and surgical patients.…”

“…Results from a small series indicate that in haemodynamically stable patients thrombolysis using tissue-type plasminogen activator might be an effective option for treatment of continuous flow left ventricular assist device pump thrombosis. 11…”