Management of Stroke in Patients with Left Ventricular Assist Devices.

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  • Additional Information
    • Source:
      Publisher: Saunders Country of Publication: United States NLM ID: 9111633 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8511 (Electronic) Linking ISSN: 10523057 NLM ISO Abbreviation: J Stroke Cerebrovasc Dis Subsets: MEDLINE
    • Publication Information:
      Publication: Philadelphia, PA : Saunders
      Original Publication: New York, NY : Demos Publications, [1991-
    • Subject Terms:
      Heart-Assist Devices* ; Ventricular Function, Left*; Anticoagulants/*administration & dosage ; Brain Ischemia/*drug therapy ; Heart Diseases/*therapy ; Intracranial Hemorrhages/*drug therapy ; Platelet Aggregation Inhibitors/*administration & dosage ; Stroke/*drug therapy; Administration, Oral ; Adult ; Aged ; Anticoagulants/adverse effects ; Brain Ischemia/diagnosis ; Brain Ischemia/physiopathology ; Disability Evaluation ; Female ; Heart Diseases/diagnosis ; Heart Diseases/physiopathology ; Humans ; Intracranial Hemorrhages/diagnosis ; Intracranial Hemorrhages/physiopathology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/adverse effects ; Recovery of Function ; Registries ; Stroke/diagnosis ; Stroke/physiopathology ; Time Factors ; Treatment Outcome
    • Abstract:
      Introduction: The number of patients with left ventricular assist devices (LVAD) is rapidly growing in industrialized countries. While cerebrovascular events comprise a significant complication, data on stroke etiology, clinical management and functional outcome are scarce.
      Methods: Consecutive LVAD patients with ischemic or hemorrhagic stroke receiving treatment at an university stroke center between 2010 and 2018 were included into an institutional registry. Clinical characteristics, causes, management and functional outcome of stroke occurring within this cohort are reported. Acceptable functional outcome was defined as mRS 0-3.
      Results: N = 30 acute strokes occurred in 20 patients (77% ischemic, 23% hemorrhagic, mean age 57 ± 13 years, 10% female, 8 patients (40%) had more than one event). 87% of all events happened with non-pulsatile devices, on average 9 (IQR 3-22) months after the implantation. All patients used oral anticoagulation with a Vitamin-K antagonist in combination with anti-platelets. The international normalized ratio (INR)-values were outside the therapeutic range in 39% of ischemic strokes and in 57% of hemorrhagic strokes. Ischemic strokes were predominantly of cardioembolic origin (92%) and of mild to moderate clinical severity (median NIHSS 6 (IQR 4-10). None qualified to receive intravenous thrombolysis or intra-arterial endovascular therapy. 61% of IS-patients showed an acceptable functional outcome after three months. 4/7 patients with hemorrhagic stroke received immediate reversal of anticoagulation without any thrombotic complications.
      Conclusion: The majority of LVAD patients with ischemic stroke had an acceptable functional outcome after three months. Future clinical research is warranted to improve therapeutic strategies for acute care and stroke prevention.
      Competing Interests: Declaration of Competing Interest None.
      (Copyright © 2020 Elsevier Inc. All rights reserved.)
    • Contributed Indexing:
      Keywords: Functional outcome; Intracerebral hemorrhage; Ischemic stroke; Left ventricular assist devices
    • Accession Number:
      0 (Anticoagulants)
      0 (Platelet Aggregation Inhibitors)
    • Publication Date:
      Date Created: 20201017 Date Completed: 20201123 Latest Revision: 20201123
    • Publication Date:
      20240829
    • Accession Number:
      10.1016/j.jstrokecerebrovasdis.2020.105166
    • Accession Number:
      33066940