Gulati G. et al., 2019: Massive retroperitoneal hemorrhage after external shock wave lithotripsy in a patient with a left ventricular assist device
Gulati G, Kiernan M, Sabe MA.
Cardiovascular Center, Tufts Medical Center, Boston, MA, United States.
Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
As left ventricular assist devices (LVADs) become more prevalent, it is increasingly likely that patients with LVADs will require non cardiac procedures. Peri-procedural anticoagulation management is challenging in these patients and requires balancing risks of bleeding and pump thrombosis. We present a case of a patient with a HeartWare LVAD who developed a massive retroperitoneal hemorrhage after external shock wave lithotripsy (ESWL) for an obstructing renal calculus and briefly review the literature regarding bleeding complications after ESWL as well as peri-procedural anticoagulation management of patients with LVADs.
Urol Case Rep. 2019 Oct 7;28:101033. doi: 10.1016/j.eucr.2019.101033. eCollection 2020 Jan. FREE ARTICLE
“As many as 10% of patients suffer pump thrombosis, even with optimal anticoagulation management”. “In LVAD patients undergoing noncardiac surgery, rates of postoperative bleeding requiring transfusion as high as 36% have been reported”.
“no data are available on the appropriate duration to hold anticoagulation preoperatively in patients undergoing noncardiac procedures or when to restart anticoagulation postoperatively.”
Obviously the cooperation between urologists and the cardiovascular department was suboptimal also reflected by the facts that none of the three authors publishing the paper in Urology Case Reports was a urologist and that URS is not mentioned as alternative in this situation.