Abstract 16420: Single-Center Experience of Thrombosis in Continuous-Flow Left Ventricular Assist Devices: Diagnosis, Management and Outcomes
Left Ventricular Assist Device related thrombosis (LVAD-T) is associated with high morbidity and mortality due to device malfunction, embolic events, and hemolysis. Diagnostic and management strategies for LVAD-T remain poorly defined and included LVAD exchange. We report our experience with the diagnosis, treatment and outcomes of patients with presenting with presumed LVAD-T.
Methods and Results: We reviewed the records of all patients treated for suspected LVAD-T at our institution between January 1, 2010 and December 31, 2011. Laboratory data and LVAD parameters were analyzed before and after treatment. Of 64 LVAD recipients, 8 patients had suspected LVAD-T as defined by heart failure symptoms, increased LVAD power and/or low flow parameters. In all cases, lactate dehydrogenase (LDH) and total bilirubin (TB) levels were elevated before treatment and decreased after therapeutic intervention (Figure). No consistent change in LVAD parameters were observed before or after treatment. Treatment success was defined by improved symptoms and/or reduced LDH and TB. Unfractionated heparin (UFH) was initiated in 7 patients with no improvement. Treatment with catheter-directed intra-cavitary thrombolysis using tissue plasminogen activator (n=2), eptifibatide (n=4), and bivalirudin (n=2) was required. Treatment complications included intracranial bleeding (n=2) and intestinal bleeding (n=2). Outcomes included death (n=2); survival to transplantation (n=5); and ongoing LVAD support (n=1).
Conclusion: LDH and TB levels are increased with LVAD-T and may correlate with thrombosis resolution. Treatment with UFH may be ineffective, therefore catheter-directed intra-cavitary thombolysis, eptifibatide infusion, or bivalirudin to resolve LVAD-T may be necessary. Based on our experience, an early treatment strategy employing direct thrombin inhibitors and/or thrombolytic therapy may be warranted for patients with suspected or confirmed LVAD-T.
- © 2012 by American Heart Association, Inc.