• Kara R Melmed, Giulio Mondellini, David Roh, Amelia Boehme, Soojin Park, Melana Yuzefpolkya, Yoshifumi Naka, Nir Uriel, Sachin Agarwal, E Sander Connolly, Jan Claassen, Paolo C Colombo, and Joshua Z Willey.
• Departments of Neurology and Neurosurgery, New York University School of Medicine, New York, New York, USA; Division of Critical Care and Hospitalist Neurology, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA. Electronic address: Kara.melmed@gmail.com.
• World Neurosurg. 2020 Nov 1; 143: e384-e390.

BackgroundHematoma expansion (HE) is associated with poor outcome in patients with intracerebral hemorrhage (ICH), but the impact on patients with an left ventricular assist device (LVAD) is unknown. We aimed to define the occurrence of HE in the LVAD population and to determine the association between HE and mortality.MethodsWe performed a retrospective cohort study of LVAD patients and intentionally matched anticoagulated controls without LVAD admitted to Columbia University Irving Medical Center with ICH between 2008 and 2019. We compared HE occurrence between patients with an LVAD and those without an LVAD using regression modeling, adjusting for factors known to influence HE. We evaluated pump thrombosis following anticoagulation reversal. We examined the association between HE and hospital mortality using Poisson regression modeling adjusting for factors associated with poor outcome.ResultsAmong 605 patients with an LVAD, we identified 28 patients with ICH meeting the study's inclusion criteria. Our LVAD ICH cohort was predominantly male (71%), with a mean age of 56 ± 10 years. The median baseline hematoma size was 20.1 mL3 (interquartile range [IQR], 8.6-46.9 mL3), and the median ICH score was 1 (IQR, 1-2). There was no significant difference in occurrence of HE in LVAD patients and matched non-LVAD patients (adjusted odds ratio [OR], 1.3; 95% confidence interval [CI], 0.4-4.2). There was an association between HE and in-hospital mortality in LVAD patients (adjusted OR, 4.8; 95% CI, 1.4-6.2).ConclusionsHE occurrence appears to be similar in LVAD and non-LVAD patients. HE has a significant impact on LVAD ICH mortality, underscoring the importance of adequate coagulopathy reversal and blood pressure management in these patients.Copyright © 2020 Elsevier Inc. All rights reserved.

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