Pump thrombosis

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Pump Thrombosis
Synonyms N/A
Pronounce N/A
Specialty N/A
Symptoms Dyspnea, Fatigue, Heart failure symptoms
Complications Stroke, Heart failure, Device malfunction
Onset
Duration
Types N/A
Causes Blood clot formation in ventricular assist device
Risks Hypercoagulability, Device design, Suboptimal anticoagulation
Diagnosis Echocardiography, Blood tests, Device interrogation
Differential diagnosis N/A
Prevention N/A
Treatment Anticoagulation therapy, Thrombolysis, Device replacement
Medication N/A
Prognosis
Frequency
Deaths N/A


Pump thrombosis is a serious complication associated with the use of ventricular assist devices (VADs), which are mechanical pumps used to support heart function and blood flow in individuals with weakened hearts. This condition involves the formation of a blood clot within the pump, which can lead to device malfunction and serious clinical consequences.

Pathophysiology

Pump thrombosis occurs when a thrombus forms within the ventricular assist device. This can obstruct blood flow, leading to increased pump power consumption and potential device failure. The formation of a thrombus is influenced by several factors, including blood flow dynamics, shear stress, and the coagulation cascade.

Risk Factors

Several risk factors contribute to the development of pump thrombosis:

  • Hypercoagulability: Conditions that increase the tendency of blood to clot can predispose patients to pump thrombosis.
  • Device-related factors: The design and material of the VAD can influence thrombosis risk. Some devices have higher thrombosis rates due to their design.
  • Suboptimal anticoagulation: Inadequate anticoagulation therapy can lead to thrombus formation.
  • Patient-related factors: Individual patient characteristics, such as genetic predisposition and comorbidities, can affect thrombosis risk.

Clinical Presentation

Patients with pump thrombosis may present with:

Diagnosis

The diagnosis of pump thrombosis involves a combination of clinical assessment and diagnostic tests:

  • Echocardiography: Used to assess heart function and detect thrombus formation.
  • Blood tests: Elevated LDH and plasma-free hemoglobin levels can indicate hemolysis due to pump thrombosis.
  • Device interrogation: Analyzing device parameters such as power consumption and flow rates can help identify thrombosis.

Management

Management of pump thrombosis includes:

  • Anticoagulation therapy: Intensifying anticoagulation to prevent further thrombus formation.
  • Thrombolysis: Use of thrombolytic agents to dissolve the thrombus.
  • Device replacement: In severe cases, surgical replacement of the VAD may be necessary.

Prognosis

The prognosis of pump thrombosis depends on the timeliness and effectiveness of treatment. Prompt intervention can prevent serious complications such as stroke and heart failure.

Prevention

Preventive strategies include:

  • Optimizing anticoagulation therapy to maintain therapeutic levels.
  • Regular monitoring of device function and patient status.
  • Use of devices with lower thrombosis risk profiles.

See Also

References

  • [1] Kirklin JK, Naftel DC, Pagani FD, et al. Pump thrombosis in the Thoratec HeartMate II device: an update analysis of the INTERMACS registry. J Heart Lung Transplant. 2015;34(12):1515-1526.
  • [2] Starling RC, Moazami N, Silvestry SC, et al. Unexpected abrupt increase in left ventricular assist device thrombosis. N Engl J Med. 2014;370(1):33-40.



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