Wert Leonhard, Hanke Jasmin S, Dogan Günes, Ricklefs Marcel, Chatterjee Anamika, Feldmann Christina, Ismail Issam, Napp L Christian, Haverich Axel, Schmitto Jan D
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
J Thorac Dis. 2018 Jun;10(Suppl 15):S1720-S1727. doi: 10.21037/jtd.2017.10.164.
Device thrombosis is one of the main complications in left ventricular assist devices (LVAD) therapy and remains a challenging issue. Data on device thrombosis management, especially on the application of direct thrombin inhibitors such as argatroban, is limited and a consensus on thrombosis management has not yet been established.
In this study we analysed retrospective clinical data obtained from 26 patients on VAD therapy who received argatroban for suspected VAD thrombosis, between April, 2012 and February, 2017.
Thirteen patients (50%) showed resolution of thrombus after argatroban therapy. Eight of 26 patients (30.8%) were free of thrombotic events 90 days after discharge. Argatroban therapy was unsuccessful in 13 patients of the study cohort, leading to subsequent VAD-exchange. Six of 13 patients with first VAD-exchange had no thrombotic events 90 days after discharge. Six patients (23.1%) suffered from bleeding, especially gastrointestinal bleeding. No hemorrhagic strokes were observed. Three patients (11.5%) did not survive the follow-up period.
Argatroban appears to be an alternative to other pharmacological treatment options in VAD thrombosis. Efficacy and safety characteristics are acceptable, but further investigation on larger populations is necessary.
装置血栓形成是左心室辅助装置（LVAD）治疗中的主要并发症之一，仍然是一个具有挑战性的问题。关于装置血栓形成管理的数据，尤其是关于直接凝血酶抑制剂（如阿加曲班）应用的数据有限，并且尚未就血栓形成管理达成共识。
在本研究中，我们分析了2012年4月至2017年2月期间接受阿加曲班治疗疑似VAD血栓形成的26例接受VAD治疗患者的回顾性临床数据。
13例患者（50%）在阿加曲班治疗后血栓溶解。26例患者中有8例（30.8%）在出院后90天无血栓形成事件。在研究队列中的13例患者中，阿加曲班治疗失败，导致随后进行VAD置换。13例首次进行VAD置换的患者中有6例在出院后90天无血栓形成事件。6例患者（23.1%）发生出血，尤其是胃肠道出血。未观察到出血性卒中。3例患者（11.5%）在随访期内死亡。
阿加曲班似乎是VAD血栓形成中其他药物治疗选择的替代方案。疗效和安全性特征是可接受的，但有必要对更多人群进行进一步研究。
