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

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. The 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 hemolysis. 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