Eptifibatide for the Treatment of HeartMate II Left Ventricular Assist Device Thrombosis

Al-Quthami, Adeeb; Jumean, Marwan; Kociol, Robb D.; Pham, Duc Thinh; Kiernan, Michael S.; DeNofrio, David; Kapur, Navin K.

doi:10.1161/circheartfailure.112.966804

Cited by 40 publications

(34 citation statements)

References 4 publications

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“…In hemodynamically stable patients, medical therapy is often employed initially, which most commonly includes highdose unfractionated heparin and fluid resuscitation with or without the addition of glycoprotein IIb/IIIA inhibitors and thrombolytics. A summary of series documenting outcomes of this approach is presented in Table 2 [8,10,[23][24][25][26][27]. While small series demonstrate a high success rate with low morbidity, an analysis of larger series demonstrate success rates ranging from 23 to 50 %, stroke from 10 to 15 %, bleeding complications of 65 %, and mortality rates of 17-52 % [8,10,23,25,27].…”

Section: Medical Versus Surgical Therapy For Pumpmentioning

confidence: 99%

“…Mehra et al [33] eloquently capture the essence of the problem of pump thrombosis when they remind the field of the following: ''The law of unintended consequences posits that a simple intervention within a complex system always creates unanticipated and often undesirable outcomes''. a The following therapy was used for the treatment of pump thrombosis: Najjar et al [12]: tPA, GP IIb/IIIa inhibitor, or heparin; Schlendorf et al [23]: intraventricular thrombolytic therapy; Starling et al [8]: intravenous anticoagulation therapy, thrombolytic agents, and antiplatelet therapy; Al-Quthami et al [24]: GP IIb/IIIa inhibitor; Tellor et al [25]: GP IIb/IIIa inhibitor; Kammouth et al [26]: intraventricular tPA; Lenneman et al [27]: GP IIa/IIIb with or without tPA GP glycoprotein, GI gastrointestinal, mo month, NA not applicable, pt patient, tPA tissue plasminogen activator …”

Section: Medical Versus Surgical Therapy For Pumpmentioning

confidence: 99%

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Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices

Stulak

Sharma

Maltais

2015

Am J Cardiovasc Drugs

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The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.

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Section: Medical Versus Surgical Therapy For Pumpmentioning

confidence: 99%

Section: Medical Versus Surgical Therapy For Pumpmentioning

confidence: 99%

Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices

Stulak

Sharma

Maltais

2015

Am J Cardiovasc Drugs

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“…We performed a comprehensive literature search using PubMed, to identify case reports [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] that relate to thrombus management in patients with continuous flow LVADs. Keywords used for the search included left ventricular assist devices, thrombosis, thrombolytic, Heart Mate II and Heart ware.…”

Section: IIImentioning

confidence: 99%

“…CT-Head scans were obtained serially, prior to initiating heparin therapy and during the 1 st week and showed evolving ischemic infarct with no intra-cranial hemorrhage (Figure 4). On day 4 with no further decrease in his LVAD power (Table 1) he was started on a continuous infusion of Eptifibatide at 1 mcg/kg/min that was increased to 1.5 mcg/kg/minfor days 6, 7 and continued at 1 mg/kg/min for days [8][9][10][11][12][13][14][15][16][17][18][19]. During this time his hemodynamics also improved allowing inotropic support with Milrinone to be weaned off.…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of a Heart mate II Left Ventricular Assist Device Thrombus in the Setting of a Massive Acute Stroke: A Case Report and Review of the Literature

Srivastava¹

2014

JCCR

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A 56-year-old Caucasian male with a cardiac history of severe nonischemic cardiomyopathy, 3 months post Heart Mate II (Thoratec, Pleasanton, CA) Left ventricular Assist Device (LVAD) implantation, presented to the hospital with a history of acute difficulty in breathing, lethargy and decreased mentation per his wife. He was transferred from an outside hospital about 5 hours since presenting there and during which time he was treated for acute heart failure with intra-venous furosemide. On examination, he was found to be in severe respiratory distress and semi-obtunded. On physical exam he had significant right hemiplegia that was not reported from the outside hospital. A "Stroke Code" was called and a stat-non-contrast-enhanced CT brain was ordered. On connecting his LVAD to the base power module, his parameters were: RPM 10,000, Power-12, Pulsatility Index-2.1, and Flow-3-4 L/min, ( Table 1). The higher power and low PI readings in the setting of acute heart failureimmediately raised the suspicion of an acute device thrombus. His wife told us that patient's symptoms of shortness of breath, dizziness and an episode of fall with no loss of consciousness had started about 4 hours prior to presentation at the outside hospital and about 9 hours prior to presentation at our hospital.His past medical history was significant for episodes of gastrointestinal bleeds secondary to small bowel AV fistulas, Vital signs on presentation at the outside hospital were: Temperature 38.1 F, Heart Rate of 90-101 beats/minute, Respiratory Rate 20-40 breaths/ minute, mean arterial pressure of 70 mmHg and oxygen saturation of 94% on VentiMask 40%. On examination at our hospital he was found to be tachypneic at 33 breaths/minute requiring Bi-level positive airway pressure (BiPAP), heart rate-106 beats/minute, mean arterial pressure-64 mmHg and oxygen saturation of 90% on VentiMask 40%. He appeared confused and lethargic. Neck exam was positive for jugular venous distension. He had decreased breath sounds bilaterally and the LVAD hum was heard on cardiac exam. On neurologic exam, he did not follow any commands, was AbstractLeft ventricular assist devices (LVADs) are increasingly used to treat patients with advanced heart failure both as a Bridge-To-Cardiac Transplantation and Destination Therapy. Device thrombosis is a well-known complication of LVADs that can be potentially catastrophic if not diagnosed early and appropriately managed. We present a case of successful treatment of a suspected Heart Mate II thrombus with systemic thrombolysis and Eptifibatide in a patient who presented with signs and symptoms of acute decompensated heart failure and an ischemic stroke. We further compiled published case reports on acute thrombosis management in contemporary continuous flow LVADs, to discern various treatment approaches available for this serious complication. Published research on optimal anti-coagulation management strategy in the setting of acute device thrombosis is limited, primarily due to the size of this cohort but also due to the ...

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“…Therapy for confirmed or suspected pump thrombus typically consists of intense anticoagulation with parenteral anticoagulants (UFH, low-molecular-weight heparin). Intravenous antiplatelet agents (glycoprotein IIb/IIIa inhibitors) and thrombolytics may be added after consultation with a heart failure specialist (Al-Quthami et al, 2012;Ensor et al, 2011;Kamouh, John, & Eckman, 2012).…”

Section: Pump Thrombosismentioning

confidence: 99%

Coagulation and Complications of Left Ventricular Assist Device Therapy

Newsom

Paciullo²

2013

Advanced Emergency Nursing Journal

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Implantation of left ventricular assist devices (LVADs) is becoming more common with the advancement of mechanical circulatory support technology and the continued insufficient number of organ donors available for heart transplantation. Modern LVADs provide a mechanically induced, nonpulsatile, continuous blood flow that drastically alters the hemodynamic and coagulation profile of patients using these devices. In addition to the risk of bleeding and thrombotic events, LVAD support can also lead to arrhythmias and infection. Although LVAD therapy can prolong life, the majority of patients will experience an adverse event following implantation and many of these complications can result in emergency department visits. By understanding the pathophysiology and management of LVAD complications, emergency nurses will be able to provide prompt and quality care for this unique patient population.

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Eptifibatide for the Treatment of HeartMate II Left Ventricular Assist Device Thrombosis

Cited by 40 publications

References 4 publications

Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices

Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices

Successful Treatment of a Heart mate II Left Ventricular Assist Device Thrombus in the Setting of a Massive Acute Stroke: A Case Report and Review of the Literature

Coagulation and Complications of Left Ventricular Assist Device Therapy

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