Bivalirudin for left ventricular assist device thrombosis
| Autor: | Indranee Rajapreyar, Phillip Weeks, Rajko Radovancevic, Marwan F Jumean, Igor D. Gregoric, Sriram Nathan, Adam Sieg, Manish K Patel, Biswajit Kar |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Heart Ventricles medicine.medical_treatment 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Recurrence Internal medicine medicine Humans Bivalirudin 030212 general & internal medicine Aged Retrospective Studies L-Lactate Dehydrogenase business.industry Thrombosis Retrospective cohort study Hematology Hirudins Middle Aged medicine.disease Peptide Fragments Recombinant Proteins Treatment Outcome Direct thrombin inhibitor Ventricular assist device Cohort Cardiology Heart-Assist Devices Cardiology and Cardiovascular Medicine business Complication Discovery and development of direct thrombin inhibitors medicine.drug |
| Zdroj: | Journal of Thrombosis and Thrombolysis. 46:496-501 |
| ISSN: | 1573-742X 0929-5305 |
| DOI: | 10.1007/s11239-018-1725-z |
| Popis: | Pump thrombosis remains a serious complication of implantable ventricular assist device therapy and is associated with increased risk of morbidity and mortality. Optimal management strategies remain controversial and are guided largely by limited literature and expert opinion. Medical management of pump thrombosis, including the use of direct thrombin inhibitors, has been associated with mixed results. The purpose of this study is to report the outcomes associated with bivalirudin therapy in LVAD patients with suspected pump thrombosis. A single-center, retrospective observational study of 15 patients with suspected pump thrombosis that were all treated with bivalirudin therapy was conducted. The majority of subjects' initial treatment courses were unsuccessful [9/15 (60%)]; however, 6/15 (40%) achieved an initial improvement in serum lactate dehydrogenase (LDH) levels and were stabilized to be successfully discharged from the hospital. Of the subjects discharged, there was a high rate of recurrence of pump thrombosis within 6 months [5/6 (83.3%)]. Bivalirudin therapy was not associated with a consistent reduction in LDH among all subjects studied, and clinical responses to therapy appear to be associated with high rates of thrombosis recurrence. This study analyzes the largest cohort to date of LVAD patients with pump thrombosis treated with bivalirudin therapy, and suggests that alternative therapies should be considered in management. |
| Databáze: | OpenAIRE |
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