Successful Treatment of Rotary Pump Thrombus With the Glycoprotein IIb/IIIa Inhibitor Tirofiban

• Published in: The Journal of heart and lung transplantation Vol. 27; no. 8; pp. 925 - 927
• Main Authors: Thomas, Martin D., BM, Wood, Clare, MN, Lovett, Mike, BSc, Dembo, Lawrence, MB BS, O'Driscoll, Gerry, MB BCh, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2008; Elsevier Science
• Subjects: Adult; Anticoagulants - therapeutic use; Aspirin - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Female; Heart-Assist Devices - adverse effects; Humans; Medical sciences; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thrombosis - drug therapy; Thrombosis - etiology; Thrombosis - prevention & control; Tyrosine - analogs & derivatives; Tyrosine - therapeutic use; Warfarin - therapeutic use; Glycoprotein IIbIIIa; Thrombus; Glycoprotein IIb; Glycoprotein IIIa; Phlebology; Antiplatelet agent; Pump; Treatment; Tirofiban; Antithrombotic agent; Circulatory system; Cardiology; Fibrinolytic; Platelet glycoprotein IIb/IIIa receptor antagonist; Biological receptor
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2008.05.015

Despite advances in blood pump technology, thrombus formation within left ventricular assist devices (LVADs) is a life-threatening complication with few therapeutic options. A 38-year-old woman who underwent rotary LVAD implantation as a bridge to cardiac transplant developed labile flows (4 to >10 liters), associated with power spikes (4 to 12 watts) and an increase in plasma free hemoglobin (0.86 g/liter), consistent with pump thrombus at Day 140 post-LVAD implantation, despite thromboprophylaxis with aspirin and warfarin. Within 12 hours of commencing an intravenous infusion of tirofiban at a rate of 0.1 μg/kg/min, there were signs of improvement of pump dysfunction, and complete resolution was evident at Day 4 with, stable flows, power consumption and normalization of plasma free hemoglobin. Tirofiban may be considered as an alternative thrombolytic treatment strategy in rotary pump thrombus to avoid the need for LVAD replacement.