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• W4224252686 abstract "Purpose There is a lack of consistent approach to pump thrombosis (PT) in ventricular assist device (VAD) supported patients. Previously, bolus thrombolysis was administered at physicians’ discretion, guided by changes in pump parameters. More recently, we adopted a strict protocol with invasive haemodynamic monitoring to target mean arterial pressure <80mmHg and continuous infusion of tissue plasminogen activator (tPA) to achieve sustained normalisation of pump flow and power derivatives. We compare outcomes following bolus protocol (BP) and strict infusion protocol (SIP). Methods Single-centre retrospective analysis of all patients treated with thrombolysis for VAD PT between 2007-2020. Patients divided into two cohorts (BP and SIP) based on PT treatment. Baseline demographics, antithrombotic therapy, pump parameters and biochemistry were collected prior to PT event, at diagnosis and following thrombolysis. Outcomes reported included need for repeated thrombolysis doses, post thrombolysis major bleeding and death, and survival to transplant. Results Mean age 51.7y, 23.5% female. All supported with Medtronic HVAD. 21 PT events in 17 patients; 10 patients with 11 cases in BP group, 7 patients with 10 cases in SIP group. SIP group had more pre-implant renal dysfunction (mean GFR 54 vs. 81ml/min/1.73m2, p=0.017), and lower stable post-implant MAP (mean 72 vs. 76, p=0.05). Repeated thrombolytic doses were never required following SIP vs. 70% following BP (p=0.01). No patients required pump exchange, however 1 in each group required urgent heart transplant listing. Numerically fewer post thrombolysis major bleeds (2 vs. 3) and deaths (0 vs. 3) following SIP compared with BP. All SIP patients survived to transplant, compared with 70% of BP patients(figure 1). Conclusion SIP is safe for treatment of PT in VAD supported patients, with excellent associated survival to transplant, and trend towards improved post-thrombolysis outcomes. There is a lack of consistent approach to pump thrombosis (PT) in ventricular assist device (VAD) supported patients. Previously, bolus thrombolysis was administered at physicians’ discretion, guided by changes in pump parameters. More recently, we adopted a strict protocol with invasive haemodynamic monitoring to target mean arterial pressure <80mmHg and continuous infusion of tissue plasminogen activator (tPA) to achieve sustained normalisation of pump flow and power derivatives. We compare outcomes following bolus protocol (BP) and strict infusion protocol (SIP). Single-centre retrospective analysis of all patients treated with thrombolysis for VAD PT between 2007-2020. Patients divided into two cohorts (BP and SIP) based on PT treatment. Baseline demographics, antithrombotic therapy, pump parameters and biochemistry were collected prior to PT event, at diagnosis and following thrombolysis. Outcomes reported included need for repeated thrombolysis doses, post thrombolysis major bleeding and death, and survival to transplant. Mean age 51.7y, 23.5% female. All supported with Medtronic HVAD. 21 PT events in 17 patients; 10 patients with 11 cases in BP group, 7 patients with 10 cases in SIP group. SIP group had more pre-implant renal dysfunction (mean GFR 54 vs. 81ml/min/1.73m2, p=0.017), and lower stable post-implant MAP (mean 72 vs. 76, p=0.05). Repeated thrombolytic doses were never required following SIP vs. 70% following BP (p=0.01). No patients required pump exchange, however 1 in each group required urgent heart transplant listing. Numerically fewer post thrombolysis major bleeds (2 vs. 3) and deaths (0 vs. 3) following SIP compared with BP. All SIP patients survived to transplant, compared with 70% of BP patients(figure 1). SIP is safe for treatment of PT in VAD supported patients, with excellent associated survival to transplant, and trend towards improved post-thrombolysis outcomes." @default.
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• W4224252686 date "2022-04-01" @default.
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• W4224252686 title "Comparison of Outcomes Following Physician Directed Bolus vs. Strict Infusion Protocol of Tissue Plasminogen Activator for Thrombolytic Treatment of Pump Thrombosis" @default.
• W4224252686 doi "https://doi.org/10.1016/j.healun.2022.01.1165" @default.
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