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Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices

Left ventricular assist device (LVAD) implantation as destination therapy (DT) is a valuable treatment option in patients with end-stage heart failure ineligible for heart transplant. However, this therapy can be complicated by life-threatening pump thrombosis (PT). This case series reports our sing...

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Autores principales: Kortekaas, Kirsten A., den Exter, Paul L., Beeres, Saskia L. M. A., Palmen, Meindert, Jukema, J. Wouter, Huisman, Menno V., Tops, Laurens F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606390/
https://www.ncbi.nlm.nih.gov/pubmed/36312273
http://dx.doi.org/10.3389/fcvm.2022.969766
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author Kortekaas, Kirsten A.
den Exter, Paul L.
Beeres, Saskia L. M. A.
Palmen, Meindert
Jukema, J. Wouter
Huisman, Menno V.
Tops, Laurens F.
author_facet Kortekaas, Kirsten A.
den Exter, Paul L.
Beeres, Saskia L. M. A.
Palmen, Meindert
Jukema, J. Wouter
Huisman, Menno V.
Tops, Laurens F.
author_sort Kortekaas, Kirsten A.
collection PubMed
description Left ventricular assist device (LVAD) implantation as destination therapy (DT) is a valuable treatment option in patients with end-stage heart failure ineligible for heart transplant. However, this therapy can be complicated by life-threatening pump thrombosis (PT). This case series reports our single-center experience with a structured systemic thrombolysis protocol in case of PT. Consecutive patients undergoing DT LVAD (HVAD, Medtronic, Framingham, MA) implantation between 2010 and April 2021 at our institution were reviewed and those with PT identified. Clinical, laboratory and LVAD specific data were collected and analyzed retrospectively. All patients with PT were treated with systemic thrombolysis according to a structured bedside protocol. Treatment was defined successful if a patient was alive at 30 days follow-up and free of recurrent PT, stroke or device exchange. Fourteen out of 94 patients experienced a PT after LVAD implantation (11%). Systemic thrombolysis was successful in 10 of 14 patients (71%) at 30 days. Two patients died within 30 days due to a hemothorax and multi-organ failure. In three patients treatment was complicated by a major bleeding; twice a hemothorax (one fatal) and one right calf bleeding. No intracerebral hemorrhage was observed. Three patients experienced a thrombotic complication within 30 days; all recurrent PT. Eleven of the 14 DT patients were discharged home after a limited hospital stay after thrombolysis (average of 11 days). In conclusion, systemic thrombolysis may be a reasonable option for life-threatening PT in this vulnerable DT group in whom device exchange is often impossible due to comorbidity.
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spelling pubmed-96063902022-10-28 Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices Kortekaas, Kirsten A. den Exter, Paul L. Beeres, Saskia L. M. A. Palmen, Meindert Jukema, J. Wouter Huisman, Menno V. Tops, Laurens F. Front Cardiovasc Med Cardiovascular Medicine Left ventricular assist device (LVAD) implantation as destination therapy (DT) is a valuable treatment option in patients with end-stage heart failure ineligible for heart transplant. However, this therapy can be complicated by life-threatening pump thrombosis (PT). This case series reports our single-center experience with a structured systemic thrombolysis protocol in case of PT. Consecutive patients undergoing DT LVAD (HVAD, Medtronic, Framingham, MA) implantation between 2010 and April 2021 at our institution were reviewed and those with PT identified. Clinical, laboratory and LVAD specific data were collected and analyzed retrospectively. All patients with PT were treated with systemic thrombolysis according to a structured bedside protocol. Treatment was defined successful if a patient was alive at 30 days follow-up and free of recurrent PT, stroke or device exchange. Fourteen out of 94 patients experienced a PT after LVAD implantation (11%). Systemic thrombolysis was successful in 10 of 14 patients (71%) at 30 days. Two patients died within 30 days due to a hemothorax and multi-organ failure. In three patients treatment was complicated by a major bleeding; twice a hemothorax (one fatal) and one right calf bleeding. No intracerebral hemorrhage was observed. Three patients experienced a thrombotic complication within 30 days; all recurrent PT. Eleven of the 14 DT patients were discharged home after a limited hospital stay after thrombolysis (average of 11 days). In conclusion, systemic thrombolysis may be a reasonable option for life-threatening PT in this vulnerable DT group in whom device exchange is often impossible due to comorbidity. Frontiers Media S.A. 2022-10-13 /pmc/articles/PMC9606390/ /pubmed/36312273 http://dx.doi.org/10.3389/fcvm.2022.969766 Text en Copyright © 2022 Kortekaas, den Exter, Beeres, Palmen, Jukema, Huisman and Tops. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Kortekaas, Kirsten A.
den Exter, Paul L.
Beeres, Saskia L. M. A.
Palmen, Meindert
Jukema, J. Wouter
Huisman, Menno V.
Tops, Laurens F.
Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices
title Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices
title_full Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices
title_fullStr Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices
title_full_unstemmed Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices
title_short Systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices
title_sort systemic thrombolysis in the management of pump thrombosis in patients with left ventricular assist devices
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9606390/
https://www.ncbi.nlm.nih.gov/pubmed/36312273
http://dx.doi.org/10.3389/fcvm.2022.969766
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