Left ventricular assist device thrombosis in the setting of supratherapeutic international normalized ratio (INR) and bleeding.
Journal
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis
ISSN: 1473-5733
Titre abrégé: Blood Coagul Fibrinolysis
Pays: England
ID NLM: 9102551
Informations de publication
Date de publication:
01 Sep 2023
01 Sep 2023
Historique:
medline:
18
8
2023
pubmed:
14
8
2023
entrez:
14
8
2023
Statut:
ppublish
Résumé
A 71-year-old female with heart failure who underwent left ventricular assist device (LVAD) placement presented for evaluation of low hemoglobin and dark stools. She also had leg pain, numbness, and weakness for which she was taking ibuprofen. She was found to have a gastrointestinal bleed, INR of 4.3, and arterial thrombi in the left leg. She was stabilized, had her anticoagulation held, and underwent mechanical thrombectomy. On hospital day 6, LVAD interrogation revealed signs of thrombosis, while subsequent labs revealed a persistently supratherapeutic INR of 5.2. The patient had the LVAD removed and underwent further hematologic workup. Her platelets remained normal throughout the admission, indicating this was not acute disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), or heparin induced thrombocytopenia (HIT). Echocardiography identified it as a primary thrombus. This case illustrates the importance of appropriate anticoagulation to balance the bleeding risk with the risk of thrombi, as well as the importance of maintaining high suspicion for LVAD thrombosis regardless of INR.
Identifiants
pubmed: 37577875
doi: 10.1097/MBC.0000000000001241
pii: 00001721-990000000-00095
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
414-418Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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