title: Bivalirudin for treatment of LVAD thrombosis: a case series.
abstract: Both platelet- and fibrin-rich thrombi have been described in patients with pump thrombosis associated with continuous flow left ventricular assist devices (LVADs). Bivalirudin is a direct thrombin inhibitor that also inhibits platelet adhesion. Compared to heparin, this hirudin analog is less immunogenic, binds to both free- and clot-bound fibrin, and has a lower risk of major bleeding. In a recently published algorithm on the step-wise approach to the diagnosis and management of LVAD thrombosis, direct thrombin inhibitors were included as a treatment option in the setting of persistent hemolysis, power spikes, and heart failure symptoms. Evidence to support the use of a direct thrombin inhibitor for LVAD thrombosis is limited and anecdotal. We describe the first case series to date of the use of bivalirudin as an alternative to heparin in six hemodynamically stable patients with a total of ten hospitalizations for HeartMate II LVAD thrombosis.
authors: From the *Department of Pharmacy, Tufts Medical Center, Boston, Massachusetts; †School of Pharmacy, Northeastern University, Boston, Massachusetts; ‡Department of Cardiology, Tufts Medical Center, Boston, Massachusetts; §Department of Cardiothoracic Surgery, Tufts Medical Center, Boston, Massachusetts; and ¶Tufts School of Medicine, Boston, Massachusetts.
authors: Lynne M
authors: LM
authors: Sylvia
authors: Linda
authors: L
authors: Ordway
authors: Duc T
authors: DT
authors: Pham
authors: David
authors: D
authors: DeNofrio
authors: Michael
authors: M
authors: Kiernan
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin