Background Patients with cardiogenic shock requiring temporary support with percutaneous ventricular assist device (pVAD), such as Impella (Abiomed Inc.), can develop heparin induced thrombocytopenia (HIT) which requires use of alternative purge solution anticoagulation. There are limited recommendations on use of anticoagulation other than standard Unfractionated Heparin in 5% Dextrose solution. Case Summary This case describes 69 year-old female who presented with symptoms of decompensated systolic heart failure and was found to be in cardiogenic shock and despite use of inotropes and vasopressors maintained low systolic blood pressure and low mixed venous oxygen saturation which lead to use of Axillary Impella 5.0 (Abiomed Inc.) who developed HIT. Purge solution anticoagulation was switched to Argatroban, but due to increased motor pressures, tPA was successfully used to maintain proper motor pressures. Ultimately patient was transferred to an outside facility for a transplant evaluation. Discussion This case demonstrates successful and safe use of tPA as an alternative purge solution although more data needed to support this finding.