Management of Intracranial Hemorrhage in Patients with a Left Ventricular Assist Device: A Systematic Review and Meta-Analysis. [Review]

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Citation: Journal of Stroke & Cerebrovascular Diseases. 30(2):105501, 2021 Feb.PMID: 33271486Institution: MedStar Washington Hospital CenterDepartment: Neurosurgery | Surgery/Surgical Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Anticoagulants/ad [Administration & Dosage] | *Blood Transfusion | *Coagulants/ad [Administration & Dosage] | *Heart Failure/th [Therapy] | *Heart-Assist Devices | *Intracranial Hemorrhages/th [Therapy] | *Neurosurgical Procedures | *Platelet Aggregation Inhibitors/ad [Administration & Dosage] | *Prosthesis Implantation/is [Instrumentation] | Adult | Aged | Anticoagulants/ae [Adverse Effects] | Blood Transfusion/mo [Mortality] | Coagulants/ae [Adverse Effects] | Drug Administration Schedule | Female | Heart Failure/di [Diagnosis] | Heart Failure/mo [Mortality] | Heart Failure/pp [Physiopathology] | Humans | Incidence | Intracranial Hemorrhages/dg [Diagnostic Imaging] | Intracranial Hemorrhages/mo [Mortality] | Male | Middle Aged | Neurosurgical Procedures/ae [Adverse Effects] | Neurosurgical Procedures/mo [Mortality] | Platelet Aggregation Inhibitors/ae [Adverse Effects] | Prosthesis Implantation/ae [Adverse Effects] | Risk Assessment | Risk Factors | Time Factors | Treatment Outcome | Ventricular Function, LeftYear: 2021ISSN:
  • 1052-3057
Name of journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke AssociationAbstract: BACKGROUND: Intracranial hemorrhage (ICH) has been reported to occur in up to 23% of patients with left ventricular assist devices (LVADs). Currently, limited data exists to guide neurosurgical management strategies to optimize outcomes in patients with an LVAD who develop ICH.CONCLUSION: Outcomes remain poor, specifically for those undergoing surgery. As experience with this population increases, prospective studies are warranted to contribute to management and prognostication . Copyright (c) 2020 Elsevier Inc. All rights reserved.METHODS: A systematic review and meta-analysis of the literature was performed to evaluate the mortality rate in these patients following medical and/or surgical management and to evaluate antithrombotic reversal and resumption strategies after hemorrhage.RESULTS: 17 studies reporting on 3869 LVAD patients and 545 intracranial hemorrhages spanning investigative periods from 1996 to 2019 were included. The rate of ICH in LVAD patients was 10.6% (411/3869) with 58.6% (231/394) being intraparenchymal hemorrhage (IPH), 23.6% (93/394) subarachnoid hemorrhage (SAH), and 15.5% (61/394) subdural hemorrhage (SDH). Total mortality rates for surgical management 65.6% (40/61) differed from medical management at 45.2% (109/241). There was an increased relative risk of mortality (RR=1.45, 95% CI: 1.10-1.91, p=0.01) for ICH patients undergoing surgical intervention. The hemorrhage subtype most frequently managed with anticoagulation reversal was IPH 81.8% (63/77), followed by SDH 52.2% (12/23), and SAH 39.1% (18/46). Mean number of days until antithrombotic resumption ranged from 6 to 10.5 days.All authors: Borazjani A, Carroll AH, Chang JJ, Dowlati E, Felbaum DR, Mueller KB, Ramirez MPOriginally published: Journal of Stroke & Cerebrovascular Diseases. 30(2):105501, 2020 Nov 30.Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-12-31
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Journal Article MedStar Authors Catalog Article 33271486 Available 33271486

BACKGROUND: Intracranial hemorrhage (ICH) has been reported to occur in up to 23% of patients with left ventricular assist devices (LVADs). Currently, limited data exists to guide neurosurgical management strategies to optimize outcomes in patients with an LVAD who develop ICH.

CONCLUSION: Outcomes remain poor, specifically for those undergoing surgery. As experience with this population increases, prospective studies are warranted to contribute to management and prognostication . Copyright (c) 2020 Elsevier Inc. All rights reserved.

METHODS: A systematic review and meta-analysis of the literature was performed to evaluate the mortality rate in these patients following medical and/or surgical management and to evaluate antithrombotic reversal and resumption strategies after hemorrhage.

RESULTS: 17 studies reporting on 3869 LVAD patients and 545 intracranial hemorrhages spanning investigative periods from 1996 to 2019 were included. The rate of ICH in LVAD patients was 10.6% (411/3869) with 58.6% (231/394) being intraparenchymal hemorrhage (IPH), 23.6% (93/394) subarachnoid hemorrhage (SAH), and 15.5% (61/394) subdural hemorrhage (SDH). Total mortality rates for surgical management 65.6% (40/61) differed from medical management at 45.2% (109/241). There was an increased relative risk of mortality (RR=1.45, 95% CI: 1.10-1.91, p=0.01) for ICH patients undergoing surgical intervention. The hemorrhage subtype most frequently managed with anticoagulation reversal was IPH 81.8% (63/77), followed by SDH 52.2% (12/23), and SAH 39.1% (18/46). Mean number of days until antithrombotic resumption ranged from 6 to 10.5 days.

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