Goodwin Kevin, Kluis Austin, Alexy Tamas, John Ranjit, Voeller Rochus
a Department of Surgery , University of Minnesota , Minneapolis , MN , USA.
b Division of Cardiology , University of Minnesota , Minneapolis , MN , USA.
Expert Rev Cardiovasc Ther. 2018 Dec;16(12):909-917. doi: 10.1080/14779072.2018.1540300. Epub 2018 Nov 13.
Associated with significant morbidity and mortality, neurological complications in adult patients with left ventricular assist devices (LVAD) approaches a prevalence as high as 25%. As the number of individuals using LVAD support grows, it is increasingly important for providers to understand the hematologic and hemodynamic changes associated with LVAD implantation, the risk factors for neurological complications and their mitigation strategies. Areas covered: PubMed searches were completed using the terms 'Left ventricular assist device and stroke' (994 results) then 'Left ventricular assist device and stroke risk factors' (199 results). Results were filtered by 'humans' (178 results). The manuscript focuses on the risk factors and mitigation strategies for stroke identified in the literature following LVAD implantation and managing this complication. Expert commentary: There is little consensus on how to accurately predict stroke risk in the LVAD population. While some recent large-scale clinical trials identified a limited number of risk factors, further research is warranted to generate reliable predictive models and treatment protocols for these patients. This should include developing novel agents and monitoring techniques to individualize anticoagulation therapy while safely balancing the risk of bleeding, thrombosis and stroke. A multi-specialty commitment is necessary to further standardize the management of these patients.
成人左心室辅助装置（LVAD）相关的神经并发症与显著的发病率和死亡率相关，其患病率高达25%。随着使用LVAD支持的个体数量增加，医疗服务提供者了解与LVAD植入相关的血液学和血流动力学变化、神经并发症的危险因素及其缓解策略变得越来越重要。涵盖领域：使用“左心室辅助装置和中风”（994条结果），然后使用“左心室辅助装置和中风危险因素”（199条结果）完成PubMed搜索。结果按“人类”进行筛选（178条结果）。本文重点关注LVAD植入后文献中确定的中风危险因素和缓解策略以及如何处理这种并发症。专家评论：对于如何准确预测LVAD人群的中风风险，几乎没有共识。虽然最近一些大规模临床试验确定了有限数量的危险因素，但仍需要进一步研究以生成针对这些患者的可靠预测模型和治疗方案。这应包括开发新型药物和监测技术，以在安全平衡出血、血栓形成和中风风险的同时实现抗凝治疗的个体化。需要多专业的共同努力来进一步规范这些患者的管理。
