Evidence map›Paper›PMID 26471178›Full record

ArticleJournal of cardiothoracic surgery2015

Thromboembolic stroke in patients with a HeartMate-II left ventricular assist device - the role of anticoagulation.

Walter M van den Bergh, Annemieke Oude Lansink-Hartgring, Abram L van Duijn, Annemarie E Engström, Jaap R Lahpor, Arjen J C Slooter

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of cardiothoracic surgery, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
1.6field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.

  1. Pooled it
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  5. Management of epistaxis in patients with ventricular assist device: a retrospective review.Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale · 2018
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Walter M van den BerghDepartment of Intensive Care, UMC Utrecht, Utrecht, The Netherlands. w.m.van.den.bergh@umcg.nl.
Annemieke Oude Lansink-HartgringDepartment of Critical Care, UMC Groningen, University of Groningen, PO BOX 30 001, Groningen, 9700 RB, The Netherlands.
Abram L van DuijnDepartment of Intensive Care, UMC Utrecht, Utrecht, The Netherlands.
Annemarie E EngströmDepartment of Cardiothoracic Surgery, UMC Utrecht, Utrecht, The Netherlands.
Jaap R LahporDepartment of Cardiology, AMC, University of Amsterdam, Amsterdam, The Netherlands.
Arjen J C SlooterDepartment of Intensive Care, UMC Utrecht, Utrecht, The Netherlands.
University Medical Center Utrecht · NLUniversity of Amsterdam · NLUniversity of Groningen · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeIt is unknown what the optimal anticoagulant level is to prevent thromboembolic stroke in patients with left ventricular assist device (LVAD) support. We aimed to evaluate the relation between coagulation status and the occurrence of thromboembolic stroke in HeartMate-II LVAD assisted patients.

methodsThirty-eight consecutive patients with a HeartMate-II LVAD were included. Coagulation status was classified according to INR and aPTT ratio at: 1) the moment of first thromboembolic stroke; and 2) during the two weeks preceding the first thromboembolic stroke to assess long-term coagulation status. In patients without stroke, coagulation status was determined just before heart transplant, VAD explantation or death, whichever came first, and at two weeks preceding these surrogate endpoints. Based on coagulation status, patients were divided in two groups: Group I (reference group) was defined as INR below 2 and aPTT ratio below 1.5; Group II (adequate anticoagulation) as INR above 2 or aPTT ratio above 1.5. Logistic regression analysis was performed to assess the odds ratio for developing stroke for patients with adequate anticoagulation compared to the reference Group.

resultsThromboembolic stroke occurred in six (16 %) patients, none within 2 weeks after LVAD implantation. Considering coagulation status at the time of event, patients in coagulation Group II had no decreased risk for thromboembolic stroke (OR 0.78; 95 % CI 0.12-5.0). Results for coagulation status 2 weeks prior of event could not be calculated as all six strokes occurred in Group II.

conclusionIn our experience anticoagulation within predefined targets is not associated with a reduced thromboembolic stroke risk in patients with a HeartMate-II LVAD on antiplatelet therapy. However, no firm statement about the effect of either anticoagulant or antiaggregant therapy can be made based on our study. A larger randomized study is needed to support the hypothesis that there may be no additional benefit of coumarin or heparin therapy compared with antiplatelet therapy alone.

Indexed as

AdultAnticoagulantsAspirinFemaleHeart-Assist DevicesHeart FailureHeparinHumansInternational Normalized RatioMaleMiddle AgedPartial Thromboplastin TimePostoperative ComplicationsStrokeThromboembolismAnticoagulantsAspirinHeparin

Identifiers

PMID26471178
PMCPMC4606546
OpenAlexW2127126818

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.