Eptifibatide for the Treatment of HeartMate II Left Ventricular Assist Device Thrombosis
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- glycoprotein IIb/IIIa inhibitor
- HeartMate II
- left ventricular assist device
Left ventricular assist device (LVAD) thrombosis is a life-threatening complication occurring in ≈6% of patients receiving a HeartMate II (HMII) LVAD (Thoratec Corp, Pleasanton, CA) within 24 months after implantation.1 Prophylactic therapy with aspirin and warfarin to an international normalized ratio (INR) of 1.5 to 2.5 is recommended to prevent LVAD thrombosis in most HMII recipients.2 For device malfunction because of pump thrombosis, surgical device exchange may be necessary but carries a high risk of morbidity and mortality. Alternate treatment approaches include the addition of clopidogrel, tirofiban, and thrombolysis.3 We report our experience with eptifibatide (Merck & Co, Inc, Whitehouse Station, NJ), a platelet glycoprotein IIb/IIIa receptor inhibitor, for the treatment of LVAD thrombosis in 2 patients.
A 66-year-old male with ischemic cardiomyopathy who underwent HMII implantation as a bridge to cardiac transplantation developed LVAD thrombosis 42 days after his surgery while taking 325 mg of aspirin and warfarin. His INR was subtherapeutic at 1.3. Hematuria, a lactate dehydrogenase level of 2326 IU/L, direct bilirubin of 0.8 mg/dL, a lower pulsatility index, and pump flow compared with previous levels, which suggested hemolysis and …