Treatment of device thrombus in the HeartWare HVAD: Success and outcomes depend significantly on the initial treatment strategy

Stulak, John M.; Dunlay, Shannon M.; Sharma, Shashank; Haglund, Nicholas; Davis, Mary B.; Cowger, Jennifer; Shah, Palak; Masood, F.; Aaronson, Keith D.; Pagani, Francis D.; Maltais, Simon

doi:10.1016/j.healun.2015.10.020

Cited by 53 publications

(29 citation statements)

References 18 publications

(25 reference statements)

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“…Stulak et al reported a cumulative risk of pump thrombus for his entire cohort of 14, 24 and 25%, at 1, 3 and 5 years. In accordance with the above cited data, pre-2011 data showed a high overall incidence of thrombosis of 30% and a much lower rate of 7.6% after change of strategy [13,41 ▪▪ ,42 ▪▪ ].…”

Section: Burden Of Bridge To Transplant Therapysupporting

confidence: 79%

New role of ventricular assist devices as bridge to transplantation

Reineke

Mohaçsi²

2017

Current Opinion in Organ Transplantation

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Purpose of reviewProgress of ventricular assist devices (VAD) technology led to improved survival and apparently low morbidity. However, from the European perspective, updated analysis of EUROMACS reveals a somewhat less impressive picture with respect to mortality and morbidity.Recent findingsWe describe the great demand of cardiac allografts versus the lack of donors, which is larger in Europe than in the United States. Technical progress of VADs made it possible to work out a modern algorithm of bridge-to-transplant, which is tailored to the need of the particular patient. We analyze the burden of patients undergoing bridge-to-transplant therapy. They are condemned to an intermediate step, coupled with additional major surgery and potential adverse events during heart transplantation.SummaryBased on current registry data, we do have to question the increasingly popular opinion, that the concept of heart transplantation is futureless, which seems to be for someone who treats and compares both patients (VAD and heart transplantation) in daily practice, questionable. Up to now, left ventricular assist device therapy remains a bridge to a better future, which means a bridge to technical innovations or to overcome the dramatic lack of donors in Europe.

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Section: Burden Of Bridge To Transplant Therapysupporting

confidence: 79%

New role of ventricular assist devices as bridge to transplantation

Reineke

Mohaçsi²

2017

Current Opinion in Organ Transplantation

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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: 63%

“…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%

Operating in the Dark

Kiernan¹,

Katz²

2016

Circ: Heart Failure

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“…Patients who underwent initial surgical management with pump exchange had a 100% survival with no hemorrhagic strokes or death (16). Najjar et al described 34 patients with pump thrombosis, of whom 30 were treated with initial medical therapy and 4 underwent pump exchange.…”

Section: Incidence and Etiology Of Thrombosismentioning

confidence: 99%

The Use of Eptifibatide Alone or in Combination With Heparin or Argatroban for Suspected Thrombosis in Patients With Left Ventricular Assist Devices

et al. 2017

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Pump thrombosis and hemolysis in patients with left ventricular assist devices (LVADs) are associated with significant morbidity and mortality. Intensification of anticoagulation has been suggested as potential therapy, with mixed results. The aim of this study is to assess the safety and efficacy of adding eptifibatide with or without an anticoagulation agent in managing patients with LVAD presenting with hemolysis and suspected pump thrombosis. This retrospective single center study included all patients who presented with their first episode of suspected pump thrombosis and were treated with eptifibatide with or without an anticoagulant between March 1, 2011 and July 30, 2015. A total of 27 patients (23 HeartMate II, 4 HeartWare) were identified. The average age was 55 years (range 19-75) and time from implant to event averaged 513 days (range 35-1760). The average lactate dehydrogenase on presentation was 1111 and 63% of patients had power elevations. The average international normalized ratio (INR) on admission was 2.4, with INR of ≥2 in 21/27 patients. All patients received eptifibatide: 10 received eptifibatide only, 9 received eptifibatide and argatroban, and 8 received eptifibatide and heparin. Warfarin was continued in 25/27 patients. Overall, 21 patients (77.8%) were successfully treated medically, 5 (18.5%) underwent pump exchange, and 1 (3.7%) died. There were no differences in outcomes or complications between the three treatment groups. Despite initial success, 12/21 patients developed repeat episodes of hemolysis at 1 year. The 1-year survival in the patients treated medically was 90% and surgically was 60%. Our experience indicates that medical therapy for hemolysis and suspected LVAD thrombosis with warfarin and eptifibatide alone or in combination with argatroban or heparin appears safe and may be effective, although the episodes of recurrent hemolysis after medical management remain high.

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Treatment of device thrombus in the HeartWare HVAD: Success and outcomes depend significantly on the initial treatment strategy

Cited by 53 publications

References 18 publications

New role of ventricular assist devices as bridge to transplantation

New role of ventricular assist devices as bridge to transplantation

Operating in the Dark

The Use of Eptifibatide Alone or in Combination With Heparin or Argatroban for Suspected Thrombosis in Patients With Left Ventricular Assist Devices

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