Successful Treatment of Ventricular Assist Device Associated Ventricular Thrombus with Systemic Tenecteplase

Hayes, Helen; Dembo, L.; Larbalestier, Robert; O’Driscoll, Gerry

doi:10.1016/j.hlc.2007.04.012

Cited by 21 publications

(20 citation statements)

References 13 publications

(6 reference statements)

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“…Intraventricular thrombus and device thrombosis in a small number of reported cases have been successfully treated with thrombolytic therapy [19,20]. Postoperative bleeding is similar to other devices, and hemolysis has not been a frequent adverse event with this device [21].…”

Section: Hematologic Events Associated With Continuous Blood Flowmentioning

confidence: 99%

Hematologic Effects of Continuous Flow Left Ventricular Assist Devices

Slaughter

2010

J. of Cardiovasc. Trans. Res.

103

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The extent of hematologic effects of the new continuous flow left ventricular assist devices (CF-LVAD) has not been studied. Recent clinical studies have demonstrated that hemolysis and thrombosis are not common during CF-LVAD support, however, the incidence of bleeding remains a concern. The rate of postoperative bleeding is similar to that of the prior generation pulsatile LVAD, but gastrointestinal bleeding due to angiodysplasia and arteriovenous malformations is more common and appears to be related to the blood flow rheology of these devices. New evidence suggests that acquired von Willebrand's disease develops in some patients due to the reduction in high molecular weight (HMW) multimers of von Willebrand's factor (vWF). Similar to acquired von Willebrand's disease seen in patients with aortic stenosis, the shear stress of the CF-LVAD may cause proteolysis of the HMW multimers of vWF. In addition to acquired von Willebrand's disease, there is activation of the fibrinolytic system and a loss of platelet numbers and function during CF-LVAD support. The hematologic responses during CF-LVAD support are constantly changing, and antiplatelet therapy may need to be adjusted accordingly. Considerable research is needed to better define the complex hematologic effects during CF-LVAD support. Screening of patients for angiodysplasia and von Willebrand's disease before CF-LVAD implant may allow for effective preemptive treatment. Because bleeding causes significant morbidity for this population, more effective treatment strategies need to be developed.

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Section: Hematologic Events Associated With Continuous Blood Flowmentioning

confidence: 99%

Hematologic Effects of Continuous Flow Left Ventricular Assist Devices

Slaughter

2010

J. of Cardiovasc. Trans. Res.

103

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“…Even if systemic thrombolysis may usually be successfully administered in case of Jarvick 2000 ventricular thrombosis or device thrombosis [17, 18], it could be inapplicable and/or ineffective for high thrombus burden, comorbidities, or unstable patient's coagulable state. Thus, ART could represent the best solution in such complex patient subsets, as the one reported in the present case.…”

Section: Discussionmentioning

confidence: 99%

Novel application of angiojet rheolytic thrombectomy for massive thrombosis of the native aortic valve and jarvick 2000 ventricular assist device in a patient with end‐stage heart failure

Barbieri

Bertelli

Sangiorgi

2011

Cathet Cardio Intervent

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With the diffusion of implantable ventricular assist pumps in heart failure patients refractory to treatments or ineligible to transplantation, acute aortic valve and device thrombosis is an unusual but potentially increasing complication. We report a novel application of Angiojet rheolytic thrombectomy for acute and massive thrombosis of the native aortic valve and of the left ventricular assist device in a heart failure patient. The technical execution and clinical experience with this technique is described.

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“…5,6 The mechanism for device thrombus formation is multifactorial. Platelet activation markers are elevated in end-stage heart failure and remain high after LVAD implantation.…”

Section: Discussionmentioning

confidence: 99%