{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:49:55Z","timestamp":1792194595106,"version":"4.4.0"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T00:00:00Z","timestamp":1682985600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with cardiogenic shock requiring temporary support with percutaneous ventricular assist device, such as Impella (Abiomed, Inc.), can develop heparin-induced thrombocytopenia (HIT) which requires use of alternative purge solution anticoagulation. There are limited recommendations on use of anticoagulation other than standard Unfractionated Heparin in 5% dextrose solution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case summary<\/jats:title><jats:p>This case describes 69-year-old female who presented with symptoms of decompensated systolic heart failure and was found to be in cardiogenic shock and despite use of inotropes and vasopressors maintained low systolic blood pressure and low mixed venous oxygen saturation which lead to use of axillary Impella 5.0 (Abiomed, Inc.) who developed HIT. Purge solution anticoagulation was switched to Argatroban, but due to increased motor pressures, tissue plasminogen activator (tPA) was successfully used to maintain proper motor pressures. Ultimately, patient was transferred to an outside facility for a transplant evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This case demonstrates successful and safe use of tPA as an alternative purge solution although more data needed to support this finding.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad231","type":"journal-article","created":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T17:42:43Z","timestamp":1683049363000},"source":"Crossref","is-referenced-by-count":4,"title":["Tissue plasminogen activator for axillary Impella 5.0 with heparin-induced thrombocytopenia as a treatment of choice for acute Impella thrombosis: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0291-8459","authenticated-orcid":false,"given":"Elena","family":"Merino","sequence":"first","affiliation":[{"name":"Department of Medicine, Morristown Medical Center, Atlantic Health System , 100 Madison Ave., Morristown, NJ 07960 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-9212","authenticated-orcid":false,"given":"Omar M","family":"Abdelfattah","sequence":"additional","affiliation":[{"name":"Department of Medicine, Morristown Medical Center, Atlantic Health System , 100 Madison Ave., Morristown, NJ 07960 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,5,2]]},"reference":[{"key":"2023051217153035200_ytad231-B1","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1161\/CIRCULATIONAHA.119.044007","article-title":"The evolving landscape of Impella use in the United States among patients undergoing percutaneous coronary intervention with mechanical circulatory support","volume":"141","author":"Amin","year":"2020","journal-title":"Circulation"},{"key":"2023051217153035200_ytad231-B2","doi-asserted-by":"crossref","DOI":"10.1097\/CCE.0000000000000772","article-title":"Evaluation of thrombocytopenia in patients receiving percutaneous mechanical circulatory support with an Impella device","volume":"4","author":"Houry","year":"2022","journal-title":"Crit Care Explor"},{"key":"2023051217153035200_ytad231-B3","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1007\/s11239-019-01837-6","article-title":"Management of anticoagulation with Impella\u00ae percutaneous ventricular assist devices and review of new literature","volume":"48","author":"Succar","year":"2019","journal-title":"J Thromb Thrombolysis"},{"key":"2023051217153035200_ytad231-B4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.3390\/jcdd8120161","article-title":"Heparin-induced thrombocytopenia under mechanical circulatory support by large Impella for acute cardiogenic shock","volume":"8","author":"Sugimura","year":"2021","journal-title":"J Cardiovasc Dev Dis"},{"key":"2023051217153035200_ytad231-B5","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1161\/01.CIR.103.14.1838","article-title":"Argatroban anticoagulant therapy in patients with heparin-induced thrombocytopenia","volume":"103","author":"Lewis","year":"2001","journal-title":"Circulation"},{"key":"2023051217153035200_ytad231-B6","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1016\/j.jacc.2022.02.052","article-title":"Anticoagulation for percutaneous ventricular assist device-supported cardiogenic shock","volume":"79","author":"Vandenbriele","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2023051217153035200_ytad231-B7","doi-asserted-by":"crossref","DOI":"10.1097\/MAT.0000000000001349","article-title":"Use of tissue plasminogen activator Alteplase purge solution in an Impella 5.5 heart pump","volume":"67","author":"Tunney","year":"2021","journal-title":"ASAIO J"},{"key":"2023051217153035200_ytad231-B8","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/phar.2356","article-title":"Use of tissue plasminogen activator Alteplase for suspected Impella thrombosis","volume":"40","author":"Succar","year":"2020","journal-title":"Pharmacother J Hum Pharmacol Drug Ther"},{"key":"2023051217153035200_ytad231-B9","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1002\/phar.2629","article-title":"Optimizing anticoagulation for patients receiving Impella support","volume":"41","author":"Beavers","year":"2021","journal-title":"Pharmacother J Hum Pharmacol Drug Ther"}],"container-title":["European Heart Journal - 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