The use of eptifibatide for suspected pump thrombus or thrombosis in patients with left ventricular assist devices

Tellor, Bethany; Smith, Jennifer; Prasad, Sunil; Joseph, Susan; Silvestry, Scott C.

doi:10.1016/j.healun.2013.11.002

Cited by 52 publications

(36 citation statements)

References 17 publications

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“…6 Nonetheless, several observational reports have recently demonstrated that medical therapy is associated with substantial treatment failure, and intensification of antithrombotic therapies may be associated with a high risk of complications, including intracranial hemorrhage. [7][8][9] From a medical perspective, heparin was the primary antithrombotic therapy utilized at these 2 centers to treat hemolysis and, similar to other reports, was largely ineffective. 9,10 What is less clear is whether or not alternative antithrombotic regimens may have resulted in greater success.…”

Section: See Article By Levin Et Almentioning

confidence: 65%

“…When used to treat LVAD hemolysis, platelet glycoprotein IIb/IIIa inhibitors have been associated with high rates of bleeding and limited therapeutic efficacy. 8 Additionally, although a small case series did describe a potentially favorable clinical response to the direct thrombin inhibitor, Bivalirudin, half of the patients ultimately had recurrent hemolysis after transitioning to oral Coumadin. 11 Early experiences with device exchange, on the other hand, were associated with high perioperative morbidity and mortality.…”

Section: See Article By Levin Et Almentioning

confidence: 99%

“…Although hemolysis has been described with the HVAD device, 10 the preponderance of data comes from the HeartMate II population. Response to medical therapy is low with both devices, [7][8][9][10] although it is unclear if they might respond differently to specific interventions. The onset of hemolysis with the HeartMate II is typically subacute over weeks, 4 and the source of thrombus is commonly associated with pannus formation at the inflow or outflow bearings.…”

Section: See Article By Levin Et Almentioning

confidence: 99%

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Operating in the Dark

Kiernan¹,

Katz²

2016

Circ: Heart Failure

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Section: See Article By Levin Et Almentioning

confidence: 65%

Section: See Article By Levin Et Almentioning

confidence: 99%

Section: See Article By Levin Et Almentioning

confidence: 99%

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Operating in the Dark

Kiernan¹,

Katz²

2016

Circ: Heart Failure

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“…Third, our medical therapy approach did not include true thrombolytic therapy and eptifibatide as this has been shown to be associated with a high risk of intracranial bleeding in HM II patients. 21 Fourth, the histological make up of thrombus, such as fresh versus chronic clot may alter management strategy and clot histology was not verified in this analysis. In this context, it should be noted that the time to detection of the hemolysis event in each group was similar.…”

Section: Discussionmentioning

confidence: 83%

Watchful Waiting in Continuous-Flow Left Ventricular Assist Device Patients With Ongoing Hemolysis Is Associated With an Increased Risk for Cerebrovascular Accident or Death

Levin

Saeed

Willey

et al. 2016

Circ: Heart Failure

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Background— Management of hemolysis in the setting of suspected device thrombosis in continuous-flow left ventricular assist device patients varies widely, ranging from watchful waiting with intensified antithrombotic therapy to early surgical device exchange. The aim of this study was to compare the outcomes of hemolysis events treated with surgical interventions versus medical management alone. Methods and Results— A retrospective review of Heartmate II continuous-flow left ventricular assist device patients at 2 centers from January 2009 to September 2014 was completed. Patients were categorized as surgical management if hemolysis refractory to intensification of standard antithrombotic therapy was treated surgically. The primary end point was the first occurrence of cerebrovascular accident (CVA) or death. Sixty-four hemolysis events occurred in 49/367 patients implanted with Heartmate II continuous-flow left ventricular assist devices. Of 49 primary hemolysis events, 24 were treated with surgical interventions. After surgical treatment, 1 patient died and 2 experienced CVAs, as compared with 3 deaths and 9 CVAs in the 25 patients who remained on intensified antithrombotic therapy alone. The 1-year freedom from CVA or death was 87.5% and 49.5% in the surgical and medical cohorts, respectively ( P =0.027). Resolution of a primary hemolysis event without CVA or death occurred in 21/24 patients treated with surgical interventions and in 13/25 who remained on medical therapy alone. A similar association between treatment and outcome was noted in the 15 recurrent hemolysis events. Conclusions— Hemolysis refractory to intensification of antithrombotic therapy identifies continuous-flow left ventricular assist device patients at major risk for CVA and death. Early device exchange should be considered to minimize these risks.

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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%

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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The use of eptifibatide for suspected pump thrombus or thrombosis in patients with left ventricular assist devices

Cited by 52 publications

References 17 publications

Operating in the Dark

Operating in the Dark

Watchful Waiting in Continuous-Flow Left Ventricular Assist Device Patients With Ongoing Hemolysis Is Associated With an Increased Risk for Cerebrovascular Accident or Death

Management of Pump Thrombosis in Patients with Left Ventricular Assist Devices

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