Izzy S, et al. - The incidence of post-left ventricular assist device (LVAD) ischemic and hemorrhagic strokes, their relationship with stroke risk factors, and their impact on mortality were determined in this study. In patients on LVAD support, stroke was a major cause of morbidity and mortality. Results of this study suggested that chronic obstructive pulmonary disease increases the risk of ischemic stroke, though dialysis could increase the risk of hemorrhagic stroke. As compared with ischemic stroke, post-LVAD hemorrhagic stroke was linked to higher mortality.

Methods

• Information were gathered prospectively on all patients with LVADs implanted at Brigham and Women’s Hospital.
• Retrospectively collected clinical data was included for these analyses.

Results

• One hundred eighty-three patients (median age, 57; 80% male) underwent implantation of HeartMate II LVAD as a bridge to transplant (52%), destination therapy (39%), or bridge to transplant candidacy (8%) from 2007 to 2016.
• The data presented in this work showed a total of 48 strokes occurred in 39 patients (21%): 28 acute ischemic strokes in 24 patients (13%) and 20 intracerebral hemorrhages in 19 patients (10.3%).
• Among those who developed post-LVAD stroke, first events occurred at a median of 238 days from implantation (interquartile range, 93–515).
• It was noted that all but 9 patients (4.9%) were on warfarin (goal international normalized ratio, 2–3.5) and all received aspirin (81–325 mg).
• The findings suggested that patients with chronic obstructive pulmonary disease were more likely to have an ischemic stroke (odds ratio, 2.96; 95% confidence interval, 1.14–7.70).
• Outcomes revealed that dialysis-dependent patients demonstrated a trend toward a higher risk of hemorrhagic stroke (odds ratio, 6.31; 95% confidence interval, 0.99–40.47).
• It was observed in the findings that hemorrhagic stroke was linked with higher mortality (odds ratio, 3.92; 95% confidence interval, 1.34–11.45) than ischemic stroke (odds ratio, 3.17; 95% confidence interval, 1.13–8.85).