Lysis in patient with a pump thrombosis after implantation of a left ventricular assist device

Background: Left ventricular assist device implantation is an established therapy in patients with end-stage heart failure. Limitations in the durability of these pumps are the development of a pump thrombosis. A lysis therapy may avoid a surgical pump exchange. In a retrospective study we analyzed the efficacy of a lysis therapy in LVAD patients.

Methods: A pump thrombosis was diagnosed to high power or flow, increased LDH levels (>500 U/L) and hematuria. Low dose of Actilyse were given if two of three criteria were fulfilled.

Results: Between 4/12 and 8/2013, 30 lysis were done in 11 patients with different left ventricular assist device (HVAD, HeartMate II, Synergy). In 36% the lysis therapy was successful with normalization of LVAD parameter and LDH level. An exchange of the pump was necessary in 6 patients in spite of lysis therapy. Bleeding complications occurred in 13% after lysis therapy. One patient died due to intracerebral bleeding.

Conclusion: Low dose lysis therapy has a low complications rate but has to be done in most of the patients several times. An exchange of the LVAD pump is a high risk surgical procedure but can be avoided by using lysis therapy only in one third of the patients with a pump thrombosis.