Unusual Case of Pump Thrombosis in LVAD Patient with COVID-19 — Diagnostic Challenges

We present the first reported case of left ventricular assist device (LVAD) pump thrombosis in the setting of the coronavirus pandemic. We describe the clinical features of the case which helped to differentiate coronavirus disease 19 (COVID-19) from LVAD pump thrombosis. The patient is 56-year-old female supported by destination LVAD therapy. She was originally implanted with a HeartMate II device in 2015 and underwent two pump exchanges in 2017 and 2019 for pump thrombosis, despite medication adherence. Shortly after routine lab work revealed near doubling of her lactate dehydrogenase (LDH) levels, she tested positive for COVID-19. She then developed power spikes and symptomatic heart failure, which prompted hospital admission. An initial computed tomography (CT) scan showed bilateral ground glass opacities, but repeat testing was negative for COVID-19. Her LVAD pump thrombosis was treated with aspirin, unfractionated heparin, and cangrelor, which was guided by thromboelastogram. Over several weeks, her LDH returned to baseline, and she was transitioned from cangrelor to ticagrelor and from heparin to warfarin. A repeat CT scan after several days of IV diuresis showed resolution of the ground glass opacities