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Initial conservative management strategy of HeartWare left ventricular assist device thrombosis with intravenous heparin or bivalirudin.

Authors
  • Bouzas-Cruz, Noelia1, 2
  • Gonzalez-Fernandez, Oscar1
  • Ferrera-Durán, Carlos1, 3
  • Woods, Andrew4
  • Robinson-Smith, Nicola4
  • Tovey, Sian4
  • Jungschleger, Jérôme4, 5
  • Booth, Karen4, 5
  • Shah, Asif4, 5
  • Parry, Gareth1, 4, 5
  • MacGowan, Guy A1, 5, 6
  • Schueler, Stephan4, 5
  • 1 Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK.
  • 2 University of Santiago de Compostela, Santiago, Spain. , (Spain)
  • 3 Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain. , (Spain)
  • 4 Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.
  • 5 Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.
  • 6 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.
Type
Published Article
Journal
The International Journal of Artificial Organs
Publisher
SAGE Publications
Publication Date
Jul 01, 2020
Volume
43
Issue
7
Pages
444–451
Identifiers
DOI: 10.1177/0391398819896585
PMID: 31885316
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Pump thrombosis is a serious left ventricular assist device complication, though there are no guidelines regarding its treatment. The main aim of this study was to describe a strategy of intravenous anticoagulation as the initial treatment in these patients and then to compare intravenous heparin with bivalirudin. All consecutive patients who received a HeartWare left ventricular assist device from July 2009 to March 2019 were retrospectively analysed. Patients developing a pump thrombosis were selected, and treatment, outcomes and complications were recorded. During this period of time (116 months), 220 patients underwent HeartWare left ventricular assist device implantation and 57 developed pump thrombosis, with an incidence rate of first pump thrombosis of 0.17 events per patient-year of support (incidence rate of all episodes of pump thrombosis: 0.30 events per patient-year of support). All the patients were initially treated medically, predominantly with either intravenous heparin (n = 26) or bivalirudin (n = 16). Patients treated with bivalirudin during the first pump thrombosis episode had less subsequent re-thrombosis episodes (18.7% vs 57.7%, p < 0.05). In addition, percentage time in therapeutic range was greater for bivalirudin compared with heparin (68.5% ± 16.9% vs 37.4% ± 31.0%, p < 0.01). During the first pump thrombosis episode, 26.3% of the patients needed surgery (left ventricular assist device exchange (n = 8), transplant (n = 6) or decommissioning (n = 1)). The overall survival at 1 year was 61.4%, and there was no significant difference in survival. Left ventricular assist device thrombosis is a serious life-threatening complication; hence, we propose an initial conservative management of pump thrombosis with enhanced intravenous anticoagulation with either intravenous heparin or bivalirudin, with surgery reserved for refractory cases.

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