Journal article
Management of Ischemic Stroke Following Left Ventricular Assist Device
Journal of stroke and cerebrovascular diseases, Vol.29(12), pp.105384-105384
12/2020
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105384
PMID: 33254382
Abstract
Acute ischemic stroke is a common complication and an important source of morbidity and mortality in patients with left ventricular assist devices. There are no standardized protocols to guide management of ischemic stroke among patients with left ventricular assist device. We evaluated our experience treating patients who had an acute ischemic stroke following left ventricular assist device placement.
We retrospectively reviewed all patients who underwent left ventricular assist device placement from 2010–2019 and identified patients who had acute ischemic stroke following left ventricular assist device placement.
Of 216 patients having left ventricular assist device placement (mean±SD age 52.9±16.2 years, women 26.9%), 19 (8.8%) had acute ischemic stroke (mean±SD age 55.8±12.0 years, women 36.8%). Median (interquartile range) time to ischemic stroke following left ventricular assist device placement was 96 (29-461) days. At the time of the ischemic stroke, 16/19 (84.2%) patients were taking both antiplatelet and anticoagulation therapy, 1/19 (5.3%) patient was receiving only anticoagulants, 1/19 (5.3%) patient was taking aspirin and dipyridamole, and 1/19 (5.3%) patient was not taking antithrombic agents. INR was subtherapeutic (INR<2.0) in 7/17 (41.2%) patients. No patient was eligible to receive thrombolytic therapy, while 5/19 (26.3%) underwent mechanical thrombectomy. Anticoagulation was continued in the acute stroke phase in 11/19 (57.9%) patients and temporarily held in 8/19 (42.1%) patients. Hemorrhagic transformation of the ischemic stroke occurred in 6/19 (31.6%) patients. Anticoagulation therapy was continued following ischemic stroke in 4/6 (66.7%) patients with hemorrhagic transformation.
While thrombolytic therapy is frequently contraindicated in the management of acute ischemic stroke following left ventricular assist device, mechanical thrombectomy remains a valid option in eligible patients. Anticoagulation is often continued through the acute phase of ischemic stroke secondary to concerns for LVAD thrombosis. The risks and benefits of continuing anticoagulation must be weighed carefully, especially in patients with large infarct volume, as hemorrhagic transformation remains a common complication.
Details
- Title: Subtitle
- Management of Ischemic Stroke Following Left Ventricular Assist Device
- Creators
- Leigh A Rettenmaier - Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USAAayushi Garg - Department of Neurology, University of Iowa, Iowa City, IA, USAKaustubh Limaye - Department of Neurology, University of Iowa, Iowa City, IA, USAEnrique C Leira - Department of Neurology, University of Iowa, Iowa City, IA, USAHarold P Adams - Department of Neurology, University of Iowa, Iowa City, IA, USAAmir Shaban - Department of Neurology, University of Iowa, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- Journal of stroke and cerebrovascular diseases, Vol.29(12), pp.105384-105384
- DOI
- 10.1016/j.jstrokecerebrovasdis.2020.105384
- PMID
- 33254382
- NLM abbreviation
- J Stroke Cerebrovasc Dis
- ISSN
- 1052-3057
- eISSN
- 1532-8511
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 12/2020
- Academic Unit
- Neurology; Radiology; Epidemiology; Iowa Neuroscience Institute; Neurosurgery; Ophthalmology and Visual Sciences
- Record Identifier
- 9984070958302771
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