Device thrombosis remains a complication of long-term mechanical circulatory support with HeartMate II.Retrospective analysis of patients who underwent destination therapy (DT) with HeartMate II from January 2010-December 2013 at Tulane University Medical Center.Eighteen HeartMate II were implanted for DT. Survival rates were 72.2% at 1 year and 37% at 2 years. Device thrombosis in 7 of the 18 patients (39%) accounted for the low survival rate at 2 years. Known risk factors for device thrombosis were equally present in patients with and without device thrombosis. In contrast to patients without device thrombosis, all patients with device thrombosis had a pre-existing systemic inflammatory condition.Patients with pre-existing systemic inflammatory conditions are at risk of device thrombosis during DT.