TY  - BOOK
AU  - Chang, Jason J
AU  - Dowlati, Ehsan
AU  - Felbaum, Daniel R
TI  - Management of Intracranial Hemorrhage in Patients with a Left Ventricular Assist Device: A Systematic Review and Meta-Analysis. [Review]
SN  - 1052-3057
PY  - 2021///
KW  - *Anticoagulants/ad [Administration & Dosage]
KW  - *Blood Transfusion
KW  - *Coagulants/ad [Administration & Dosage]
KW  - *Heart Failure/th [Therapy]
KW  - *Heart-Assist Devices
KW  - *Intracranial Hemorrhages/th [Therapy]
KW  - *Neurosurgical Procedures
KW  - *Platelet Aggregation Inhibitors/ad [Administration & Dosage]
KW  - *Prosthesis Implantation/is [Instrumentation]
KW  - Adult
KW  - Aged
KW  - Anticoagulants/ae [Adverse Effects]
KW  - Blood Transfusion/mo [Mortality]
KW  - Coagulants/ae [Adverse Effects]
KW  - Drug Administration Schedule
KW  - Female
KW  - Heart Failure/di [Diagnosis]
KW  - Heart Failure/mo [Mortality]
KW  - Heart Failure/pp [Physiopathology]
KW  - Humans
KW  - Incidence
KW  - Intracranial Hemorrhages/dg [Diagnostic Imaging]
KW  - Intracranial Hemorrhages/mo [Mortality]
KW  - Male
KW  - Middle Aged
KW  - Neurosurgical Procedures/ae [Adverse Effects]
KW  - Neurosurgical Procedures/mo [Mortality]
KW  - Platelet Aggregation Inhibitors/ae [Adverse Effects]
KW  - Prosthesis Implantation/ae [Adverse Effects]
KW  - Risk Assessment
KW  - Risk Factors
KW  - Time Factors
KW  - Treatment Outcome
KW  - Ventricular Function, Left
KW  - MedStar Washington Hospital Center
KW  - Neurosurgery
KW  - Surgery/Surgical Critical Care
KW  - Journal Article
KW  - Review
N2  - 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
UR  - https://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105501
ER  -