Abstract Details

Title A Retrospective Analysis of Anticoagulation Reinstitution in Patients with Left Ventricular Assist Device who Developed Intracerebral Hemorrhage at Mayo Clinic Arizona

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-057

Objective To characterize reinstitution of anticoagulation in patients with left ventricular assist device who developed intracerebral hemorrhage.

Background

Patients with a left ventricular assist device (LVAD) receive anticoagulation along with antiplatelet therapy to prevent pump thrombosis. Stroke is a life threatening complication of LVAD therapy. Neurological impairment and disability are serious sequelae of stroke particularly after intracerebral hemorrhage (ICH), the deadliest and most disabling form of stroke. There are no guidelines and sparse data exist regarding the safety and efficacy of restarting anticoagulation after ICH in this patient population.

Design/Methods This is a retrospective, single academic center review of LVAD patients presenting to Mayo Clinic Arizona from 2010-2017. The primary endpoint was occurrence of ICH while on an LVAD anticoagulation and antiplatelet therapy. Secondary endpoints include pre and post-ICH antiplatelet and anticoagulation dosing, INR at time of ICH, and timing of resumption of antiplatelet and anticoagulation regimen. Exclusion criteria included death prior to anticoagulation resumption.

Results Retrospective chart review revealed 370 patients with a LVAD. Eight patients developed an ICH. Five patients were excluded from analysis after they were transitioned to comfort care secondary to complications from brainstem compression and obstructive hydrocephalus, thus follow-up scans were not performed. The remaining three patients were receiving aspirin (81-325mg daily) and warfarin (6-10mg daily) with an INR of 2.57-3.99 (mean=3.28) at the time of ICH. Aspirin was held during hospitalization. Warfarin was resumed 2-8 (mean=5) days post ICH at 1-2mg. The patients were free of ischemic stroke and ICH recurrence at 90 days and two year follow-up.

Conclusions In this review of 370 patients with LVAD, eight patients developed an ICH. Approximately 38% of these patients survived. Warfarin was safely resumed as early as 24 hours post-ICH ictus. Further studies are needed to determine optimal timing of LVAD antithrombotic regimen resumption.

Authors/Disclosures
Sara Dawit, MD PRESENTER	Dr. Dawit has nothing to disclose.
	No disclosure on file
	No disclosure on file
William D. Freeman, MD, FAAN (Mayo Clinic)	Dr. Freeman has nothing to disclose.
Cumara B. O'Carroll, MD, FAAN (Mayo Clinic)	Dr. O'Carroll has nothing to disclose.

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