title: Effective treatment with a new protocol using tissue-type plasminogen activator thrombolysis for pump thrombosis with the HVAD device.
abstract: Pump thrombosis is a major complication of the continuous flow left ventricular assist device. Pump exchange is seen as the therapeutic gold standard. In this study, we report on our experience with using tissue-type plasminogen activator thrombolysis for therapy of pump thrombosis.
  We report on our experience with treatment of continuous flow left ventricular assist device pump thrombosis with the HVAD using tissue-type plasminogen activator thrombolysis in nine patients with 16 thrombotic events. In all events we used a uniform treatment protocol.
  All patients presented with a sufficient anticoagulation and had symptoms of heart failure. However, all patients were haemodynamically stable. Six of nine patients presented with a mean arterial pressure above 85 mm Hg and every patient presented with an infection. In all events we achieved short-term success with resolution of the pump thrombosis within a median time of nine hours. Three of nine patients developed recurrent pump thrombosis after >60 days. Besides one case of nonfatal intracranial haemorrhage and one case of minor bleeding, there were no adverse events.
  Our data indicates that using a uniform treatment protocol that builds on usage of tissue-type plasminogen activator thrombolysis might be an effective tool for treatment of continuous flow left ventricular assist device pump thrombosis in haemodynamically stable patients. Additionally, our data indicates that infection may be a potential trigger for pump thrombosis.
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Schrage
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Germany.
authors.forename: Hanno
authors.initials: H
authors.lastname: Grahn
authors.affiliation: 2 Department of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, Germany.
authors.forename: Florian M
authors.initials: FM
authors.lastname: Wagner
authors.affiliation: 2 Department of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Bernhardt
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Rybczynski
authors.affiliation: 1 Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: 2 Department of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: 2 Department of Cardiovascular Surgery, University Heart Center Hamburg Eppendorf, Germany.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Barten
mesh_terms: D000328:Adult; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Continuous flow left ventricular assist devices; infection; pump thrombosis; thrombolysis; tissue-type plasminogen activator