alexa Between Scylla and Charybdis: Difficult Balance between Anticoagulation and Bleeding in the Management of LVAD Thrombosis: A Case Report
ISSN: 2329-6607

Cardiovascular Pharmacology: Open Access
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Case Report

Between Scylla and Charybdis: Difficult Balance between Anticoagulation and Bleeding in the Management of LVAD Thrombosis: A Case Report

Perna E*, Cipriani MG*, De Marco F, Macera F, Milazzo F, Garascia A, Ammirati E, D’Angelo L, Gagliardone MP, Russo CF and Frigerio M

De Gasperis Cardio Center, Niguarda Ca’ Granda Hospital, Italy

*Corresponding Authors:
Perna E
De Gasperis Cardio Center, Niguarda Ca’ Granda Hospital
Piazza Ospedale Maggiore 3, 20162 Milan, Italy
Tel: +393332106609
Fax: 02 64442566
E-mail: [email protected]

Cipriani MG
De Gasperis Cardio Center, Niguarda Ca’ Granda Hospital
Piazza Ospedale Maggiore 3, 20162 Milan, Italy
Tel: +393332106609
Fax: 02 64442566
E-mail: [email protected]

Received Date: January 04, 2016 Accepted Date: February 10, 2016 Published Date: February 15, 2016

Citation: Perna E, Cipriani MG, Marco DF, Macera F, Milazzo F, et al. (2016) Between Scylla and Charybdis: Difficult Balance between Anticoagulation and Bleeding in the Management of LVAD Thrombosis: A Case Report. Cardiovasc Pharm Open Access 5:173. doi:10.4173/2329-6607.1000173

Copyright: © 2016 Perna E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Abstract

Case: The patient was a 67 years old male. The patient experienced an episode of LVAD thrombosis. Device replacement was not possible due to high surgical risk. Pharmacological strategy was adopted with intraventricular fibrinolysis+intravenous Tirofiban infusion. Outcome: Despite thrombosis resolution, two episodes of bleeding occurred. Thus we lowered antithrombotic drugs dose with subsequent relapse risk. At the end, a successful therapeutic strategy was achieved. Conclusion: Our case report shows how the balance between anticoagulation and bleeding is a tricky feature of LVAD thrombosis management. When device replacement is not an option, trying to remove the clot soon with aggressive antithrombotic therapy can be a winning strategy and can quickly stop the haemolysis. Unfortunately, it can produce major bleeding events, harmful and potentially life-threatening. To be aware of potential cause of bleeding and looking for the appropriate dosage of antithrombotic drugs can be useful to manage these complications

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