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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
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Medication management for left ventricular assist device thrombosis
Elizabeth Hohner1, Jessica Crow1, Michael P Moranville2
1Elizabeth Hohner, Pharm.D., is Postgraduate Year 2 Emergency Medicine Resident; Jessica Crow, Pharm.D., BCPS, is Clinical Pharmacy Specialist; and Michael P. Moranville, Pharm.D., BCPS (AQ-Cardiology), is Clinical Pharmacy Specialist, Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.
Summary
Left ventricular assist devices (LVADs) improve heart failure outcomes, but pump thrombosis is a risk. Optimal antithrombotic therapy and monitoring are key to managing LVAD thrombosis and preventing complications.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis Research
Background:
- Left ventricular assist devices (LVADs) significantly benefit patients with advanced heart failure.
- Continuous-flow LVADs have led to increased reports of pump thrombosis, a serious complication.
- Pump thrombosis can cause device dysfunction and adverse clinical outcomes.
Purpose of the Study:
- To discuss current strategies for preventing and treating pump thrombosis in LVAD patients.
- To review the role of anticoagulation and antiplatelet therapies.
- To explore medical versus surgical management options for LVAD thrombosis.
Main Methods:
- Review of current literature on LVAD pump thrombosis.
- Analysis of anticoagulation and antiplatelet therapy regimens.
- Evaluation of medical and surgical treatment approaches.
Main Results:
- Optimal antithrombotic regimens for LVADs are not yet clearly defined.
- International Normalized Ratio (INR) goals should be individualized based on device and patient factors.
- Medical management carries risks of bleeding and recurrent thrombosis, while surgical intervention may be necessary.
Conclusions:
- Close monitoring for LVAD thrombosis is crucial for early detection.
- Medical management can be an early strategy but requires careful consideration of bleeding risks.
- Pump exchange or heart transplantation may be definitive treatments for refractory LVAD thrombosis.
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