Clot Buster Can Unclog Heart Pump

A study has found that injecting a clot-buster drug into patients with left ventricular assist devices (LVADs) can restore blood flow when clotting complications occur. The study was published in the September 16, 2002, issue of Circulation.

According to reports, up to 47% of all patients with a pulsatile LVAD develop clotting complications. In the current study, the device used was the MicroMed DeBakey VAD, which differs from similar devices in being smaller and able to reduce the incidence of thromboembolism and infection. However, its axial pump appears to be associated with a higher risk of clot formation. Out of 22 patients with this device, the pump flow was critically reduced in eight. In seven cases, the pump worked harder, indicating clot formation inside the device. In one case, the demand on the pump was very low, indicating that a clot was in the opening of the device.

Following administration of thrombolytic therapy with rt-PA (recombinant tissue plasminogen activator), no emergency surgical device exchange was needed and no severe bleeding complications occurred. All patients were discharged from intensive care after therapy was discontinued. Four patients had nose bleeds for three days. Six patients went on to successful heart transplantation, and two died on LVAD support because of multiorgan failure.

"This is such a simple solution to a very serious problem for heart failure patients who receive left ventricular assist devices,” said Markus Rothenburger, M.D., a resident in cardiovascular surgery at University Hospital in Muenster, Germany (www.uni-muenster.de), and lead author of the study.





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