Use of Bivalirudin in Treatment of Acute Left Ventricular Assist Device Thrombosis: Case Series

J. Janjua, P. Jewel-Ripp, J. H. Blabaum, D. Pham, R. Dhingra

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE: Bivalirudin has been used in treatment of left ventricular assist device thrombosis (LVAD) however, outcomes remain unclear. METHODS: We retrospectively examined 10 patients (21 admissions) admitted for suspected left ventricular assist device (LVAD) thrombosis and were treated with bivalirudin. Diagnosis and treatment response were based on hemolysis markers and LVAD parameters. RESULTS: Overall patients were younger (mean age 48years, 90% males) and heavier (mean BMI 35.2 kg/m2). 9/10 patients had Heartmate II and 1 had HeartWare device. 6 patients had LVAD implant as a bridge to transplant. All patients were on warfarin with mean INR of 2.8±0.8 on presentation. Over the course of hospitalization, in general LDH levels showed a biphasic response peaking between day 3-7 and day 21-25 (Figure). With bivalirudin therapy (median duration 28days), 4 patients were successfully discharged from hospital, 2 died and 4 underwent LVAD exchange. Patients who underwent LVAD exchange had recurrent thrombosis requiring urgent transplant (n=2), repeat LVAD exchange (n=1) or died (n=1). Out of the 4 patients who were discharged initially, 1 required urgent transplant, 1 had LVAD exchange with HM III, 1 died and 1 had repeated thrombosis episodes treated conservatively with bivalirudin. 10/21 (47.6%) hospitalizations were treated successfully with bivalirudin. Recurrent thrombotic episodes generally happened after 3 months (mean 100.54 days). CONCLUSION: Although bivalirudin therapy was partially successful in treatment of LVAD thrombosis, long term outcomes of these patients without transplantation were poor.

Original languageEnglish (US)
Pages (from-to)S448-S449
JournalThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2020
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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