Neurologic Complications in Patients with Left Ventricular Assist Devices: Single Institution Retrospective Review

Whitaker-Lea, Wittstatt Alexandra; Toms, B.; Toms, Jamie; Shah, Keyur B.; Quader, Mohammed; Tang, Daniel; Kasirajan, Vigneshwar; Rivet, Dennis J.; Reavey‐Cantwell, John

doi:10.1016/j.wneu.2020.04.064

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…In brief, ischemic stroke should be managed similarly to non‐LVAD patients, with prompt assessment by neurology and interventional radiology 98 . Limited data suggest that thrombolytic therapy can be safely considered in appropriate candidates 99 . In non‐lytic candidates, IV anticoagulation and oral antiplatelet therapy should be initiated 98 .…”

Section: Hemocompatibility Eventsmentioning

confidence: 99%

Pharmacotherapy for durable left ventricular assist devices

Hollis¹,

Doligalski²,

Jennings

2021

Pharmacotherapy

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Left ventricular assist devices (LVADs) have revolutionized the care of patients with advanced heart failure, yet still require concomitant medications in order to achieve the best possible clinical outcomes. Since the outset of routine placement of durable, continuous‐flow LVADs, much of the medication management of these patients to date has been based on International Society of Heart and Lung Transplantation (ISHLT) guidance, most recently published in 2013. Since 2013, numerous multidisciplinary pharmacotherapy publications have increased the LVAD community's understanding of best practices with respect to medications. We identified the major domains of LVAD medication management and conducted a comprehensive search of US National Library of Medicine MEDLINE® database using keywords chosen to identify medication‐related publications of significance dated 2013 or later. Trials pertaining to the HeartMate II™ and the HeartMate™ 3 LVADs (Abbott, Chicago, IL) and the HeartWare™ HVAD™ System (Medtronic, Minneapolis, MN) were chosen for inclusion. Highest priority for inclusion was given to prospective, randomized, controlled studies. Absent these, controlled trials (retrospective or prospective observational) were given next‐highest consideration, followed by retrospective uncontrolled studies, and finally case series. Reference lists of qualified publications were reviewed to find any other publications of interest that were not discovered on initial search. Case reports were generally excluded, except where the insight gained was deemed to be uniquely pertinent. This document serves to provide a comprehensive review of the current understanding of optimal medication management in patients with durable, continuous‐flow LVADs.

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Section: Hemocompatibility Eventsmentioning

confidence: 99%

Pharmacotherapy for durable left ventricular assist devices

Hollis¹,

Doligalski²,

Jennings

2021

Pharmacotherapy

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“…16 In a single-center series that included 30 LVAD patients presenting with AIS, four patients underwent a total of five mechanical thrombectomies (three right M1 LVOs and two left M1 LVOs, with one patient who underwent two mechanical thrombectomies 1 week apart). 8 All of the thrombectomies achieved a TICI 3 result without secondary hemorrhage. Post-operatively, one patient was left with no residual deficit, two had mild deficits, and one remained with severe deficit.…”

Section: Discussionmentioning

confidence: 92%

“…There are few published reports on the use of IV TPA as acute therapy for LVAD-related stroke as its use is often contraindicated in the setting of therapeutic anticoagulation or recent thoracic surgery. 5,8 Furthermore, the use of systemic thrombolysis has been explicitly omitted in previously published treatment algorithms. 17 Given the concurrent use of multiple antithrombotic agents, concerns of baseline coagulopathy related to possible acquired von Willibrand factor deficiency, and the increased risk of hemorrhagic transformation associated with cardioembolic events, TPA is likely to be of high risk in LVAD patients.…”

Section: Discussionmentioning

confidence: 99%

“…Previous small observational studies reported relatively higher rates of MT use in patients with LVAD compared to the general population and comparable rates of successful reperfusion. 4,5,7,8 However, large-scale analyses of its use and post-stroke outcomes are lacking. Using a nationwide database, the aim of this study was to compare post-thrombectomy outcomes in patients with and without LVAD support.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical thrombectomy after acute ischemic stroke in patients with left ventricular assist devices: A nationwide analysis

Mandigo

Sisti

Lavine

et al. 2022

International Journal of Stroke

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Introduction Left ventricular assist devices (LVADs) are an established, durable and lifesaving treatment option for patients with advanced heart failure. However, large vessel occlusions (LVOs) remain one of its most devastating embolic complications. Mechanical thrombectomy (MT) is safe and effective in the management of LVOs in the general population but LVO trials largely excluded patients on mechanical circulatory support and large-scale analyses of outcomes following these interventions in the LVAD population are lacking. Methods Using the National Inpatient Sample, we identified all adult patients hospitalized with acute ischemic stroke (AIS) from 2005-2018. Regression models adjusting for patient demographics, hospital factors, and clinical severity were used to compare outcomes following MT in patients with and without LVAD. Subgroup analyses were also performed in LVAD patients experiencing stroke in the post-operative setting and stroke in the setting of pre-existing devices. Results Of the 1,633,234 AIS hospitalizations identified, 794 occurred in patients with LVADs. 61% were postoperative. Post-stroke in-hospital mortality was higher among patients with LVADs (23.3% vs 7.23%, P<0.001). Among those receiving MT, mortality was also higher in the LVAD population (31.0% vs 14.1%, P=0.009), though this was largely driven by the post-operative LVAD subgroup. In multivariable analysis, only post-operative LVAD patients experienced greater odds of in-hospital death after MT (aOR: 8.66, CI:1.46-51.3); patients with pre-existing LVADs demonstrated no difference in post-MT mortality (aOR: 1.06; 95% CI: 0.29-3.91) or in odds of discharge home after MT (aOR 0.63, CI: 0.17-2.32) Conclusion Our data suggests MT is not a futile treatment approach in patients with pre-existing LVADs and may result in similar rates of good outcomes. Additional research is needed to evaluate the long-term benefits of endovascular therapy after stroke in patients on LVAD support.

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