Thrombolytics in VAD management - A single-center experience.

Area of Science:

• Cardiology
• Biomedical Engineering
• Pharmacology

Background:

• Mechanical circulatory support devices, such as left ventricular assist devices (LVADs), are increasingly used.
• Device thrombus remains a significant challenge in patients with LVADs.
• Assessing the safety and efficacy of thrombolytic therapy in LVAD patients is crucial.

Purpose of the Study:

• To evaluate the safety and efficacy of tissue plasminogen activator (TPA) for treating thrombus in durable mechanical assist devices.
• To analyze outcomes in patients receiving TPA for LVAD-related thrombus.

Main Methods:

• Retrospective analysis of 154 LVAD patients (2005-2014).
• Diagnosis of LVAD thrombus based on elevated lactate dehydrogenase, clinical signs, echocardiography, and pump power surges.
• TPA protocol involved an initial bolus and infusion, with potential for extended treatment.

Main Results:

• A 70% success rate was observed with TPA, defined by resolution of hemolysis and clinical symptoms without LVAD exchange at 30 days.
• Survival at 30 days was 95% in the TPA group.
• Hemorrhagic stroke rates were similar between the TPA and control groups (OR = 0.92).

Conclusions:

• The described TPA protocol demonstrated consistent success in managing LVAD thrombus.
• The study highlights the need for larger, prospective studies to compare mechanical assist devices and optimize thrombolytic use.
• This research provides a foundation for future investigations into tailored thrombolytic strategies for LVAD patients.