The Role of Medical Management for Acute Intravascular Hemolysis in Patients Supported on Axial Flow LVAD

Tal Hasin, Salil Deo, Joseph J. Maleszewski, Yan Topilsky, Brooks S. Edwards, Naveen L. Pereira, John M. Stulak, Lyle Joyce, Richard Daly, Sudhir S. Kushwaha, Soon J. Park

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Continuous flow left ventricular assist devices (LVADs) are used with good outcome. However, acute intravascular hemolysis due to thrombus in the pump remains a clinical challenge. We screened for LVAD-related intravascular hemolysis among 115 consecutive patients surviving HeartMateII implantation and investigated the role of medical therapy in resolving the hemolysis. Hemolytic events were identified in 7% of patients, 2-26 months after implant, manifested by peak lactate dehydrogenase (LDH) levels >6 times normal. With the institution of heparin and enhanced antiplatelet therapy, LDH levels receded rapidly reaching a stable trough level near baseline within 2 weeks with the resolution of clinical symptoms except in one patient who required additional therapy with tissue plasminogen activator (tPA). Complications included transient renal failure, one splenic infarct, and a cerebrovascular attack after tPA. The acute event of hemolysis resolved with medical therapy, and all were successfully discharged. However, recurrent hemolysis was common (6/8 patients over the next 1-7 months). At the end of follow-up, three patients were transplanted, one patient died refusing LVAD exchange for recurrent hemolysis, and 4 remained alive on LVAD support. Medical treatment with intensification of anticoagulation can be effective in resolving the acute hemolytic event. However, a definitive long-term strategy should be planned because the recurrence rate is high.

Original languageEnglish (US)
Pages (from-to)9-14
Number of pages6
JournalASAIO Journal
Volume60
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • Heart assist device
  • hemolysis
  • management
  • outcome
  • thrombosis

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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