Evidence map›Paper›PMID 34418673›Full record

ArticleJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2021

Medical and Surgical Management of Left Ventricular Assist Device-Associated Intracranial Hemorrhage.

Chinwe Ibeh, David L Tirschwell, Claudius Mahr, Claire J Creutzfeldt

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

Article in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.8field-weighted citation impact, top 32% 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

5 citing papers in PubMed, 13 citations in OpenAlex.

  1. Review
  2. Review
  3. Article
  4. Review
  5. 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

4 authors at 2 institutions in 1 country.

Chinwe IbehDepartment of Neurology, Columbia University Irving Medical Center, 710 W 168th St, New York, NY 10032, United States. Electronic address: ci73@cumc.columbia.edu.
David L TirschwellDepartment of Neurology, University of Washington, Seattle, WA, United States. Electronic address: tirsch@uw.edu.
Claudius MahrDivision of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States. Electronic address: CMahr@cardiology.washington.edu.
Claire J CreutzfeldtDepartment of Neurology, University of Washington, Seattle, WA, United States. Electronic address: clairejc@uw.edu.
University of Washington · USColumbia University Irving Medical Center · US

Funding

NEUROEPIDEMIOLOGY TRAINING PROGRAMT32NS007153 · NINDS · COLUMBIA UNIV NEW YORK MORNINGSIDE · PI GU, YIAN, WILLEY, JOSHUA ZEBADIAH · 1987 to 2023
$6.2M
Navigating Patients and Families through the Neuro-ICUK23NS099421 · NINDS · UNIVERSITY OF WASHINGTON · PI CREUTZFELDT, CLAIRE JOHANNA · 2017 to 2021
$951k
NINDS NIH HHS K23 NS099421NINDS NIH HHS T32 NS007153
6 · The paper itself

Abstract

objectivesManagement of left ventricular assist device (LVAD)-associated intracranial hemorrhage (ICH) is complicated by the competing concerns of hematoma expansion and the risk of thrombosis. Strategies include reversal or withholding of anticoagulation (AC) and neurosurgical (NSG) interventions. The consequences of these decisions can significantly impact both short- and long-term survival. Currently no guidelines exist. We reviewed medical and NSG practices following LVAD-associated ICH and analyzed outcomes. MATERIALS AND

methodsRetrospective analysis of data collected between 2012-2018 was performed. Survival probability following ICH was calculated using the Kaplan-Meier method.

resultsOut of 283 patients, 32 (11%) had 34 ICHs: 16 intraparenchymal (IPH, 47%), 4 subdural (SDH, 12%), and 14 subarachnoid (SAH, 41%). IPH tended to occur sooner (median 138 [IQR 48 - 258] days post-LVAD placement) and be more neurologically devastating (mean GCS 11.4 [4.4]). Antithrombotics were reversed in 27 (79%); 1 thrombotic event occurred while off AC. Following resumption, re-hemorrhage occurred in 7 (25%), a median of 13 days (IQR 8-30) post-ICH. Five underwent NSG intervention and 6 (18%) went on to receive heart transplant. Overall, 30-day mortality was 26% (38% in IPH, 0% in SDH, and 29% in SAH), but rose to 44% at 6 months.

conclusionICH is a common post-LVAD complication with high short- and long-term mortality, though ICH subtypes may not be equally devastating. Despite this, some may benefit from neurosurgical intervention and do well following cardiac transplant. Anticoagulation is frequently reversed after ICH. Resumption however should be approached cautiously in patients with LVADs given their possible baseline coagulopathy.

Indexed as

Neurosurgical ProceduresVentricular Function, LeftAdultAgedAged, 80 and overAnticoagulantsFemaleFibrinolytic AgentsHeart-Assist DevicesHeart FailureHeart TransplantationHumansIntracranial HemorrhagesMaleMiddle AgedProsthesis ImplantationAnticoagulantsFibrinolytic AgentsAnticoagulationHeart failureIntracranial hemorrhageLeft ventricular assist deviceNeurosurgeryStrokeThrombosis

Identifiers

PMID34418673
PMCPMC8511228
OpenAlexW3195943964

What OpenQuestion holds

Textmetadata
LicenceTDM
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.