Original Research
Tuesday, October 15, 2024
08:30 AM–10:00 AM
Abstract
Introduction:
There is no recognized standard of care for medical treatment of durable left ventricular assist device (LVAD) pump thrombosis.
Research Question or Hypothesis:
Describe outcomes of alteplase administration (using a modified, extended Webber approach) for LVAD pump thrombosis at a non-transplant US center.
Study Design:
Single-center, retrospective, observational cohort study
Methods:
Adult patients with a durable LVAD admitted between January 2012 and December 2021 who received intravenous alteplase for suspected pump thrombosis were included. Our standard dosing regimen included a 10 mg bolus over one minute, followed by a 20 mg bolus over twenty minutes, then a continuous infusion at 1 mg per hour. Providers trended LDH and pump function to determine when to discontinue alteplase rather than a prespecified duration. Treatment and outcome data are described.
Results:
Twenty-nine individual patients (of 227 total implanted during study period) experienced a suspected pump thrombosis. Twelve of the 29 patients received alteplase for treatment of pump thrombosis; of these, two had multiple occurrences resulting in 16 total events. All patients were supported with HeartMate II (n=6) or HeartWare HVAD (n=6) devices. The average alteplase duration per event was 49 hours (range 19.7-713 hours). The median LDH prior to discontinuation of alteplase infusion was 1276.5 IU/L (range 490-3585 IU/L) with continued downtrend to a median of 526 IU/L (range 256-2549 IU/L) at time of discharge. Three negative outcomes were noted during alteplase administration. Two bleeding events, hemorrhagic conversion of an ischemic stroke and multifocal intracranial hemorrhage, resulted in immediate discontinuation of alteplase. One episode of suspected gastrointestinal bleeding occurred prior to discharge without a change in antithrombotic regimen.
Conclusion:
Patients supported by HeartMate II and HeartWare HVAD devices who may not want or be eligible for surgical intervention in the setting of pump thrombosis require medical management options. This is the largest study describing alteplase administration in this setting to date.
Presenting Author
Jenna Foster Cox PharmDPrisma Health Richland Hospital
Authors
James Ampadu MD
Prisma Health-Midlands
Andrew Mardis PharmD
Bridgebio
Gabrielle Rhinehart MD
Prisma Health-Midlands
Laura Jane Straw PharmD
Prisma Health-Midlands
Alyson Wilder PharmD
MedStar Montgomery Medical Center