Systemic Thrombolysis Can Be a Therapy Option Only in Highly Selected Cases of Pump Thrombosis
To the Editor:
It was with great interest we read the article by Oezpeker et al.1 presenting authors’ experience with systemic thrombolysis (SL) and device exchange in cases of pump thrombosis. Undoubtedly, SL can be a therapy option. However, it is our opinion that this can only be the case in highly selected patients at high operative risk. Thrombotic material is because of its fibrous nature only partially susceptible to thrombolytic agents; risk of thrombosis recurrence is therefore high.2 Furthermore, results of SL therapy are compromised by the absence of an in vitro tested and in vivo validated dosage regiment. That means that in case of SL we currently have the choice between bleeding complications and ineffective thrombolysis. Device exchange remains therefore still the only therapy option that can be recommended in cases of pump thrombosis.
Department of Cardiac Surgery
Medical University Graz
1. Oezpeker C, Zittermann A, Ensminger S, et al.Systemic thrombolysis versus device exchange for pump thrombosis management: A single-center experience.ASAIO J201662246251
Copyright © 2016 by the ASAIO
2. Kirklin JK, Naftel DC, Kormos RL, et al.Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of pump thrombosis in the HeartMate II left ventricular assist device.J Heart Lung Transplant2014331222