Medical Management of Pump Related Thrombosis in Patients with Continuous Flow Left Ventricular Assist Devices: A Systematic Review and Meta-analysis

摘要

Pump thrombosis is a dreaded complication of left ventricular assist device (LVADs). We completed a systematic review to evaluate the efficacy and complications associated with medical management of LVAD thrombosis. Databases were searched using the terms “vad*” or “ventricular assist device” or “heart assist device” and “thrombus” or “thrombosis” or “thromboembolism”. Of 2383 manuscripts, 49 articles met the inclusion criteria. The risk of partial or no resolution of LVAD thrombosis did not significantly differ between thrombolytic and non-thrombolytic regimens (OR 0.48; 95% CI 0.20–1.16). When response to therapy was evaluated based upon pump type, there were no significant differences in how patients with a HMII or HVAD responded to thrombolytic or non-thrombolytic treatment. Pooled risk of major bleeding in the thrombolytic group was 29% (95% CI 0.17–0.44) and 12% (95% CI 0.01–0.57) in the non-thrombolytic group. Odds of death did not differ between thrombolytic and non-thrombolytic regimens (OR 1.28; 95% CI 0.42–3.89). Although thrombolytic and non-thrombolytic treatment similarly resolved LVAD thrombosis, major hemorrhage may be increased with use of thrombolysis. Randomized clinical trials comparing thrombolytic and non-thrombolytic treatment of LVAD thrombosis are needed to establish the most effective and safe option for patients who are not surgical candidates.