• Wittstatt Alexandra Whitaker-Lea, Brittney Toms, Jamie B Toms, Keyur B Shah, Mohammed Quader, Daniel Tang, Vigneshwar Kasirajan, Dennis J Rivet, and John F Reavey-Cantwell.
• Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA. Electronic address: Wittstatt.WhitakerLea@vcuhealth.org.
• World Neurosurg. 2020 Jul 1; 139: e635-e642.

BackgroundNeurologic complications are common complications encountered by patients with left ventricular assist devices (LVADs). This single-center retrospective study aims to identify the incidence and risk factors of neurologic complications and interventions in patients supported with LVADs and define the associated anticoagulation management.MethodsBetween August 2009 and August 2017, 244 patients underwent LVAD implantation. Twenty-one patients were excluded for having neurologic complications before LVAD placement or for having previously undergone heart transplantation.ResultsFifty-six patients (25%) suffered 61 complications, and 11 (19.6%) died as a result. Gender, type of LVAD, or chronic medical comorbidities evaluated did not contribute to a difference in complication rate; in contrast, length of LVAD implantation was directly related to risk of neurologic complication. Eleven patients (19.6%) underwent 13 surgical interventions including 5 mechanical thrombectomies. Anticoagulation was reversed in 16 patients and held without complication. Anticoagulation was not held for ischemic complications, and no clinically significant hemorrhagic transformation occurred. Intravenous tissue plasminogen activator was also successfully administered to 3 patients without complication.ConclusionsNeurologic complications were observed in 25% of patients supported with LVADs, of which 20% required neurosurgical intervention. Anticoagulation can be safely withheld in patients with hemorrhagic complications. Patients with ischemic complications can continue to be anticoagulated with no significant risk of hemorrhagic transformation. Length of LVAD implantation was directly related to the risk of neurologic complication. Finally, our study adds to existing literature that mechanical thrombectomy and even intravenous tissue plasminogen activator are options for LVAD patients with ischemic complications.Copyright © 2020 Elsevier Inc. All rights reserved.

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