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Initial conservative management strategy of HeartWare left ventricular assist device thrombosis with intravenous heparin or bivalirudin.
Int J Artif Organs. 2019 Dec 30 [Online ahead of print]IJ

Abstract

INTRODUCTION AND OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Authors+Show Affiliations

Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK. University of Santiago de Compostela, Santiago, Spain.Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK.Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK. Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK.Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK. Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne, UK. Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK. Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. Department of Cardiothoracic Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31885316

Citation

Bouzas-Cruz, Noelia, et al. "Initial Conservative Management Strategy of HeartWare Left Ventricular Assist Device Thrombosis With Intravenous Heparin or Bivalirudin." The International Journal of Artificial Organs, 2019, p. 391398819896585.
Bouzas-Cruz N, Gonzalez-Fernandez O, Ferrera-Durán C, et al. Initial conservative management strategy of HeartWare left ventricular assist device thrombosis with intravenous heparin or bivalirudin. Int J Artif Organs. 2019.
Bouzas-Cruz, N., Gonzalez-Fernandez, O., Ferrera-Durán, C., Woods, A., Robinson-Smith, N., Tovey, S., Jungschleger, J., Booth, K., Shah, A., Parry, G., MacGowan, G. A., & Schueler, S. (2019). Initial conservative management strategy of HeartWare left ventricular assist device thrombosis with intravenous heparin or bivalirudin. The International Journal of Artificial Organs, 391398819896585. https://doi.org/10.1177/0391398819896585
Bouzas-Cruz N, et al. Initial Conservative Management Strategy of HeartWare Left Ventricular Assist Device Thrombosis With Intravenous Heparin or Bivalirudin. Int J Artif Organs. 2019 Dec 30;391398819896585. PubMed PMID: 31885316.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initial conservative management strategy of HeartWare left ventricular assist device thrombosis with intravenous heparin or bivalirudin. AU - Bouzas-Cruz,Noelia, AU - Gonzalez-Fernandez,Oscar, AU - Ferrera-Durán,Carlos, AU - Woods,Andrew, AU - Robinson-Smith,Nicola, AU - Tovey,Sian, AU - Jungschleger,Jérôme, AU - Booth,Karen, AU - Shah,Asif, AU - Parry,Gareth, AU - MacGowan,Guy A, AU - Schueler,Stephan, Y1 - 2019/12/30/ PY - 2019/12/31/entrez KW - HeartWare left ventricular assist device KW - Pump thrombosis KW - bivalirudin KW - heparin SP - 391398819896585 EP - 391398819896585 JF - The International journal of artificial organs JO - Int J Artif Organs N2 - INTRODUCTION AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. SN - 1724-6040 UR - https://www.unboundmedicine.com/medline/citation/31885316/Initial_conservative_management_strategy_of_HeartWare_left_ventricular_assist_device_thrombosis_with_intravenous_heparin_or_bivalirudin L2 - http://journals.sagepub.com/doi/full/10.1177/0391398819896585?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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