In this episode, I’ll discuss the use of alteplase for suspected Impella device thrombosis
An Impella device provides mechanical circulatory support, and device thrombosis is a potential complication. The purge solution for an Impella device is heparinized but despite this, thrombosis may still occur. A combination of low purge flow rates, increasing purge flow pressures, increased lactate dehydrogenase, and clinical condition may lead a clinician to suspect device thrombosis has occurred.
Clinicians at Houston Methodist Hospital have published a case series of 5 patients with suspected Impella thrombosis where the purge solution was changed from heparin to one containing alteplase.
The alteplase concentration for the purge solution was either 0.04 or 0.08 mg/ml mixed in sterile water. In all cases, alteplase administration resulted in resolution of low purge flow rates and high purge pressures. No major bleeding complications were directly associated with alteplase purge solutions.
Based on this case series, the authors concluded that alteplase appears to be an option to salvage or delay or prevent device exchange in the setting of suspected Impella device thrombosis.
To get access to my free download area with 20 different resources to help hospital pharmacists go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.