The definitive treatment of prepump thrombosis is surgical pump exchange, although medical therapy (thrombolysis, glycoprotein inhibitors, unfractionated heparin) may be applied in select cases [424]. Intrapump thrombosis should be treated with lysis, with pump exchange or an urgent transplant if possible [424–426]. Post-pump thrombosis can be treated with stenting of the outflow graft [427]. Cases of kinking or twisting of the outflow graft should be surgically corrected with untwisting of the graft or pump exchange, because stenting is not useful [420]. The recommendations are presented regarding HeartMate II (Abbott, Lake Bluff, IL, USA), HeartWare HVAD (Medtronic, Minneapolis, MN, USA) and HeartMate 3 (Abbott); no data are reported for the Jarvik Flowmaker (Jarvik Heart Inc., New York, NY, USA), HeartAssist 5 (ReliantHeart Inc., Houston, TX, USA) and Berlin Heart INCOR (Berlin Heart GmbH, Berlin, Germany), or other devices. The reported incidence of pump thrombosis is substantially lower for HeartMate 3 compared to HeartMate II [2a] and supposedly the HeartWare HVAD, although a prospective head-to-head comparison of the HeartMate 3 and the HeartWare HVAD has not yet been performed.