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Management of Stroke in Patients with Left Ventricular Assist Devices.
- Source :
-
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2020 Nov; Vol. 29 (11), pp. 105166. Date of Electronic Publication: 2020 Aug 12. - Publication Year :
- 2020
-
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.<br />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.<br />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.<br />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.<br />Competing Interests: Declaration of Competing Interest None.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- 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
Anticoagulants administration & dosage
Brain Ischemia drug therapy
Heart Diseases therapy
Heart-Assist Devices
Intracranial Hemorrhages drug therapy
Platelet Aggregation Inhibitors administration & dosage
Stroke drug therapy
Ventricular Function, Left
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8511
- Volume :
- 29
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
- Publication Type :
- Academic Journal
- Accession number :
- 33066940
- Full Text :
- https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105166