INTRODUCTION A left ventricular assist device (LVAD) is used in certain heart failure cases, but LVADs can have significant neurological complications including intracranial hemorrhages (ICH). Prediction and management of ICHs is challenging due to medical comorbidities and blood thinners. METHODS A retrospective review of LVAD patients with ICHs from 2015 to 2019 was performed. The data included demographics, premorbid conditions, hemorrhage type, treatments, and outcomes. RESULTS Twenty-two patients were included with a median age of 53 and a median time of 16 months from LVAD insertion to ICH. All patients were on blood thinners prior to ICH. The hemorrhage type included subarachnoid hemorrhage (41 %), intracerebral hemorrhage (32 %), and subdural hematomas (23 %). The blood-thinning agent was reversed in 64 % of patients with a median of 3.5 days prior to resumption of these medications. Ten re-hemorrhages occurred with 4 of these hemorrhages within two weeks of anticoagulation resumption. Open cranial surgery was performed in 32 % of all patients, and the mortality was 41 %. CONCLUSIONS Management of these patients is challenging with a relatively high rate of re-hemorrhage and need for surgical intervention. Despite maximal management, the mortality remains high.

中文翻译：

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LVAD 患者脑出血：病例系列和文献综述

介绍 左心室辅助装置 (LVAD) 用于某些心力衰竭病例，但 LVAD 可能具有严重的神经系统并发症，包括颅内出血 (ICH)。由于合并症和血液稀释剂，ICH 的预测和管理具有挑战性。方法 对 2015 年至 2019 年发生 ICH 的 LVAD 患者进行回顾性研究。数据包括人口统计学、病前状况、出血类型、治疗和结果。结果 包括 22 名患者，中位年龄为 53 岁，从 LVAD 插入到 ICH 的中位时间为 16 个月。所有患者在 ICH 之前都服用了血液稀释剂。出血类型包括蛛网膜下腔出血 (41%)、脑内出血 (32%) 和硬膜下血肿 (23%)。血液稀释剂在 64% 的患者中被逆转，中位数为 3。恢复这些药物前 5 天。抗凝治疗恢复后两周内发生了 10 次再出血，其中 4 次出血。32% 的患者接受了开颅手术，死亡率为 41%。结论 由于再出血率相对较高且需要手术干预，因此对这些患者的管理具有挑战性。尽管进行了最大限度的管理，但死亡率仍然很高。