Evidence map›Paper›PMID 31531758›Full record

ArticleNeurocritical care2020

The Dilemma of Resuming Antithrombotic Therapy After Intracranial Hemorrhage in Patients With Left Ventricular Assist Devices.

Christan D Santos, Nikki L Matos, Rabea Asleh, Sara Dawit, Alejandro A Rabinstein, Cumara B O'Carroll, Zhuo Li, William D Freeman

Abstract read
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In one paragraph

Article in Neurocritical care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.5field-weighted citation impact, top 37% 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

4 citing papers in PubMed, 9 citations in OpenAlex.

  1. Article
  2. Review
  3. Medical and Surgical Management of Left Ventricular Assist Device-Associated Intracranial Hemorrhage.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2021
    Article
  4. Article
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

8 authors at 4 institutions in 1 country.

Christan D SantosDepartment of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA. Santos.Christan@mayo.edu.ORCID http://orcid.org/0000-0001-5589-7001
Nikki L MatosDepartment of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Rabea AslehDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
Sara DawitDepartment of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
Alejandro A RabinsteinDivision of Critical Care and Hospital Neurology, Mayo Clinic, Rochester, MN, USA.
Cumara B O'CarrollDepartment of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
Zhuo LiDivision of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA.
William D FreemanDepartment of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Mayo Clinic in Arizona · USMayo Clinic in Florida · USJacksonville College · USWinnMed · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND/

objectiveAntithrombotic therapy is administered after left ventricular assist device (LVAD) implantation to prevent thromboembolic events. Intracranial hemorrhage (ICH) is a life-threatening adverse event requiring immediate discontinuation of antithrombotics. We investigated the timing of antithrombotic resumption after ICH in patients with LVADs and the association between timing and risk of recurrent hemorrhage and thrombotic events.

methodsWe performed a multicenter, retrospective analysis of patients with ICH occurrence during LVAD antithrombotic regimen with subsequent resumption of antithrombotics from January 1, 2010, to December 31, 2017. Covariates included age, international normalized ratio, antithrombotic dosing, timing of resumption, modified Rankin score, and subsequent hemorrhagic and thrombotic events within 1 year post-ICH. Patients who did not resume anticoagulation were excluded.

resultsOf 673 patients with LVADs, 85 (12.6%) developed ICH while being treated with antithrombotics. Forty-three were excluded due to death prior to resumption and one due to lack of resumption. The remaining 41 patients were on antithrombotics with a median (interquartile range [IQR]) international normalized ratio at ICH onset of 2.6 (1.8-3.6). Aspirin and warfarin were resumed at a median (IQR) of 5.5 (1.3-8.8) and 6.5 (4.0-15.5) days post-ICH, respectively. A continuous unfractionated heparin infusion was initiated in 16 (39.0%) patients at a median (IQR) of 2.5 (1.0-7.8) days post-ICH. During the 1-year follow-up after anticoagulation resumption, 11 (26.8%) patients suffered secondary hemorrhages and two (4.9%) suffered secondary thrombotic events. Using Kaplan-Meier method and log-rank test, we compared all patients who resumed anticoagulation by 6 days post-ICH to those who resumed after 6 days. There was no difference in freedom from secondary hemorrhagic event between the two groups (P = 0.75).

conclusionDespite timing of resumption of antithrombotic therapy after ICH, recurrent hemorrhagic events can be expected in one-quarter of these patients over the subsequent year.

Indexed as

Heart-Assist DevicesAgedAnticoagulantsAspirinDeprescriptionsFemaleFibrinolytic AgentsHeart FailureHeparinHumansInternational Normalized RatioIntracranial HemorrhagesKaplan-Meier EstimateMaleMiddle AgedPlatelet Aggregation InhibitorsAnticoagulantsAspirinFibrinolytic AgentsHeparinPlatelet Aggregation InhibitorsWarfarinAnticoagulantsAntithromboticsBrain hemorrhageIntracranial hemorrhageThrombosisVentricular assist device

Identifiers

PMID31531758
OpenAlexW2974248551

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.