We searched 5 databases (PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, clinicaltrials.gov) for neuro-monitoring in LVAD through January 2018. We followed the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations and selected only studies with TCD-emboli monitoring. 

Of 3597 articles identified, 17 studies met inclusion criteria with a total of 493 adult LVAD patients and a median age of 47 (IQR 34–55). Study designs were mostly prospective observational studies (n=12) with 2 retrospective observational and 3 case-control studies. The predominant LVAD devices studied was continuous-flow (n=372) vs.pulsatile-pump (n=121). Of the 17 articles, 182 patients had positive MES during 30-minute TCD-emboli monitoring with a median of 8 per patient (IQR1.2-47). A total of 164 thromboembolic events occurred in 90 patients (18.2%) with a median of 2 events per patient were reported after LVAD implantation(ischemic strokes=64.6%, transient ischemic events=25.6%, non-neurologic = 9.8%). Higher MES were detected during days of the thromboembolic events. During the studies, 375 patients (76%) were on various antithrombotic regimens, of which 34.8% were on therapeutic anticoagulation, 24.4% were on antiplatelet therapy(13.9% dual vs.9.5% single), 17.6% were on both, 23.9% were without antithrombotic agents. Overall, these studies reported anticoagulation was effective in reducing MES count, but remained unclear of the clinical significance of MES in relationship to future thromboembolic events.