title: The role of medical management for acute intravascular hemolysis in patients supported on axial flow LVAD.
abstract: Continuous flow left ventricular assist devices (LVADs) are used with good outcome. However, acute intravascular hemolysis due to thrombus in the pump remains a clinical challenge. We screened for LVAD-related intravascular hemolysis among 115 consecutive patients surviving HeartMateII implantation and investigated the role of medical therapy in resolving the hemolysis. Hemolytic events were identified in 7% of patients, 2-26 months after implant, manifested by peak lactate dehydrogenase (LDH) levels >6 times normal. With the institution of heparin and enhanced antiplatelet therapy, LDH levels receded rapidly reaching a stable trough level near baseline within 2 weeks with the resolution of clinical symptoms except in one patient who required additional therapy with tissue plasminogen activator (tPA). Complications included transient renal failure, one splenic infarct, and a cerebrovascular attack after tPA. The acute event of hemolysis resolved with medical therapy, and all were successfully discharged. However, recurrent hemolysis was common (6/8 patients over the next 1-7 months). At the end of follow-up, three patients were transplanted, one patient died refusing LVAD exchange for recurrent hemolysis, and 4 remained alive on LVAD support. Medical treatment with intensification of anticoagulation can be effective in resolving the acute hemolytic event. However, a definitive long-term strategy should be planned because the recurrence rate is high.
authors: From the *Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; †Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota; and ‡Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
authors: Tal
authors: T
authors: Hasin
authors: Salil
authors: S
authors: Deo
authors: Joseph J
authors: JJ
authors: Maleszewski
authors: Yan
authors: Y
authors: Topilsky
authors: Brooks S
authors: BS
authors: Edwards
authors: Naveen L
authors: NL
authors: Pereira
authors: John M
authors: JM
authors: Stulak
authors: Lyle
authors: L
authors: Joyce
authors: Richard
authors: R
authors: Daly
authors: Sudhir S
authors: SS
authors: Kushwaha
authors: Soon J
authors: SJ
authors: Park
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006461:Hemolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000209:etiology; D055815:Young Adult
chemical_list: D000925:Anticoagulants