Abstract 390: Use of Eptifibatide in patients with ventricular assist devices and Bleeding outcomes
Background: Pump thrombosis is a dreaded complication in patients with left ventricular assist devices (LVADs). Intravenous anticoagulation is often instituted prior to surgical pump exchange. The use of eptifibatide, a glycoprotein IIb/IIIa inhibitor has been reported with data showing increased adverse events by as much as 65%. This study evaluated eptifibatide use for suspected pump thrombus/thrombosis and bleeding outcomes
Methods: This was a single center retrospective study of eptifibatide use in patients with suspected pump thrombus. All LVAD patients who received eptifibatide for suspected pump thrombus from October 22, 2011, through April 19, 2014 were included. Pump thrombosis was suspected if one or more was present: elevated lactate dehydrogenase, decreased haptoglobin, elevated free plasma hemoglobin and persistently elevated powers. The study was approved by the institutional board review.
Results: A total of 17 patients (13 Heart Mate II, 3 Heart Ware and 1 Abiomed AB5000 LVAD) with 25 admission events received eptifibatide (dose range, 0.25-2 μg/kg/min). The mean time from device implantation to eptifibatide therapy was 660 days (range: 1 - 1809 days). 9 (36%) patients underwent pump exchange while the rest resolved medically. 7 (28%) patients had confirmed Pump/LVAD thrombus while 3 (12%) had major bleeding events (1-GI, 1-Oral and 1-Acute Intracranial Hemorrhage) requiring drug interruption. 8(47%) patients had combined 11 minor mucosal bleeding events (Oral-2, GU-5, GI-1 and Nasal-3) that did not require therapy interruption. 2 of the 3 (67%) patients with major bleeding died as a result.
Conclusions: Minor bleeding is more common than major bleeding with eptifibatide use in patients with suspected pump thrombus. Comparative effectiveness studies of eptifibatide therapy in suspected pump thrombosis are needed to assess risk benefit ratio.
Author Disclosures: M. Siddiqui: None. S. Mazimba: None. J.A. Tallaj: None. S.V. Pamboukian: None.
- © 2015 by American Heart Association, Inc.