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- W2072607811 abstract "Optimal management strategies for continuous-flow LVAD thrombosis (LVAD-T) have not been determined. We describe our experience with 11 pts managed for LVAD-T receiving device exchange and/or thrombolytic therapy (TPA). A chart review of pts managed for LVAD-T from 1/1/2010 to 4/1/2013 was performed. Thrombus was suspected in the setting of unexplained hemolysis with lactate dehydrogenase (LDH) >4 times ULN (700 IU/L). Treatment options for LVAD-T were made on a case-by-case basis with involvement of the patient and caregivers. Pts were considered for urgent LVAD exchange or TPA if they were hemodynamically unstable. LVAD exchange was also considered for cardioembolic events or failure to respond to TPA. Pts were otherwise treated first with a trial of antithrombotic therapy with escalation to VAD exchange or TPA if conservative therapy failed. Success of TPA was defined as thrombus resolution without serious adverse event or need for LVAD exchange. Success of VAD exchange was considered as long-term survival. Among pts receiving TPA, alteplase was administered (0.75-1 mg/min) either intravenously (n=1; 100 mg) or via an intracavitary approach (n=4; 38-90 mg). 20 of 116 pts presented with LVAD-T. 11 of 20 pts were managed with LVAD exchange and/or TPA. 5 pts underwent LVAD exchange, 5 pts were given TPA and 1 pt given TPA required exchange for recurrent LVAD-T. In addition to hemolysis, presentation included heart failure symptoms (5), VAD abnormalities (8), or thromboembolic event (3). Mean peak LDH was 1560±900 IU/L. Two pts presented with cardiogenic shock and underwent urgent LVAD exchange. 9 pts were initially managed with antithrombotic therapy alone (unfractionated heparin, eptifibatide, or bivalirudin). Due to non-response, 5 of these pts were transitioned to TPA and 4 underwent VAD exchange. Adverse events included 1 intracranial hemorrhage (TPA), 1 gastrointestinal bleed with transfusion (exchange) and 2 mediastinal hematomas (TPA-1, exchange-1). Among 6 pts initially undergoing LVAD exchange, 4 (67%) were transplanted or are alive on LVAD support and 2 died. There was 1 recurrence at 58 days in the new LVAD, treated with bivalirudin until transplant. Among 5 pts receiving TPA, 2 died (40%) and 3 were discharged. There was one recurrence at 13 days requiring exchange. The overall success of TPA at 30 days was 40% (2 pts). LVAD-T is associated with significant morbidity. In our limited experience, success was greater with LVAD exchange compared to TPA; however recurrence after exchange is possible. In the absence of data from larger cohorts, individual pt characteristics and preferences should guide decision making for this event." @default.
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- W2072607811 date "2013-08-01" @default.
- W2072607811 modified "2023-10-14" @default.
- W2072607811 title "Device Exchange and Thrombolytic Therapy for Left Ventricular Assist Device Thrombosis" @default.
- W2072607811 doi "https://doi.org/10.1016/j.cardfail.2013.06.061" @default.
- W2072607811 hasPublicationYear "2013" @default.
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