Bivalirudin for left ventricular assist device thrombosis
Pump thrombosis remains a serious complication of implantable ventricular assist device therapy and is associated with increased risk of morbidity and mortality. Optimal management strategies remain controversial and are guided largely by limited literature and expert opinion. Medical management of pump thrombosis, including the use of direct thrombin inhibitors, has been associated with mixed results. The purpose of this study is to report the outcomes associated with bivalirudin therapy in LVAD patients with suspected pump thrombosis. A single-center, retrospective observational study of 15 patients with suspected pump thrombosis that were all treated with bivalirudin therapy was conducted. The majority of subjects’ initial treatment courses were unsuccessful [9/15 (60%)]; however, 6/15 (40%) achieved an initial improvement in serum lactate dehydrogenase (LDH) levels and were stabilized to be successfully discharged from the hospital. Of the subjects discharged, there was a high rate of recurrence of pump thrombosis within 6 months [5/6 (83.3%)]. Bivalirudin therapy was not associated with a consistent reduction in LDH among all subjects studied, and clinical responses to therapy appear to be associated with high rates of thrombosis recurrence. This study analyzes the largest cohort to date of LVAD patients with pump thrombosis treated with bivalirudin therapy, and suggests that alternative therapies should be considered in management.
KeywordsBivalirudin Direct thrombin inhibitor LVAD Thrombosis Pump thrombosis
The investigators wish to acknowledge the dedication and hard work of the nurses, LVAD coordinators, advanced practice providers and all others involved in the care of LVAD patients of the Univeristy of Texas Health Science Center—Center for Advanced Heart Failure at Memorial Hermann—Texas Medical Center. In addition, thanks to R. Michelle Sauer Gehring, PhD, ELS, CRA for editorial support.
There was no outside source of funding for this study.
Compliance with ethical standards
Conflict of interest
The investigators/authors of this study declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
The need for informed consent was waived by the IRB due to the retrospective nature of the study being performed.
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