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Updated: Dec 11, 2025
In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
A Stepwise Approach to Left Ventricular Assist Device Pump Thrombosis
Sinan Sabit Kocabeyoglu1, Umit Kervan1, Dogan Emre Sert1
1Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
Insights
Pump thrombosis (PT) is a serious complication of left ventricular assist device (LVAD) therapy. Low-dose thrombolytic therapy shows promise for treating PT, with high rates of freedom from recurrent events.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis
Background:
- Pump thrombosis (PT) is a significant complication associated with left ventricular assist device (LVAD) therapy.
- Optimal treatment strategies for PT remain undefined, necessitating further research.
Purpose of the Study:
- To present a treatment strategy for patients experiencing pump thrombosis (PT) after LVAD implantation.
- To investigate risk factors associated with PT development.
Main Methods:
- Retrospective analysis of hospital records for patients undergoing LVAD implantation (May 2013 - October 2018).
- PT diagnosis based on impaired flow/power parameters and hemolysis.
- Risk factor analysis by comparing patients with and without PT.
Main Results:
- PT occurred in 20 of 81 LVAD patients, presenting with elevated lactate dehydrogenase and pump alarms.
- Initial treatment with unfractionated heparin was administered; some patients required urgent LVAD exchange or died.
- Thirteen patients received tissue plasminogen activator (tPA) infusion, with 8 discharged free of thrombosis and 3 bridged to transplant.
- Freedom from second PT was 91% at 6 months and 68.2% at 1 year.
- Larger left ventricle size and pump type were identified as PT risk factors.
Conclusions:
- Low-dose thrombolytic therapy, such as tPA infusion, is a viable treatment option for PT.
- Further investigation into PT management strategies is warranted.
Aim:
Pump thrombosis (PT) is a detrimental complication of left ventricular assist device (LVAD) therapy. There is no consensus on optimal PT treatment. The aim of this study was to present a treatment strategy for patients with PT.
Method:
The hospital records of patients who underwent isolated LVAD implantation between May 2013 and October 2018 were retrospectively evaluated. Pump thrombosis was suspected in the setting of impaired flow/power parameters and haemolysis. Protocols for the management of suspected PT varied by patient presentation. Parameters that increased the PT risk were investigated by dividing the patients into two groups according to the presence of PT. Preoperative and operative data were analysed.
Results:
Pump thrombosis was observed in 20 of 81 patients. All patients with PT presented elevated lactate dehydrogenase levels and higher power and/or low-/high-flow alarm at admission. All patients were treated initially with intravenous unfractionated heparin infusion; three patients did not require further treatment, one patient died due to sudden cardiac arrest, and three patients underwent urgent surgery for LVAD exchange. Thirteen (13) patients received tissue plasminogen activator infusion; eight were discharged without any signs of thrombosis, and three were bridged to transplant. One (1) major bleeding event leading to death was observed. Freedom from second PT was found in 91% cases at 6 months and in 68.2% at 1 year. We found that a larger left ventricle and the type of pump determined the risk of PT.
Conclusions:
Low-dose thrombolytic therapy should be considered as a feasible treatment option for patients with PT.
