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Title: Atrial fibrillation is not associated with thromboembolism in left ventricular assist device patients: A systematic review and meta-analysis
Authors: Veraprapas Kittipibul
Pattara Rattanawong
Jakrin Kewcharoen
Pakawat Chongsathidkiet
Wasawat Vutthikraivit
Napatt Kanjanahattakij
Duke University Medical Center
Texas Tech University Health Sciences Center at Odessa
Chulalongkorn University
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
University of Hawaii at Manoa
Einstein Medical Center
Keywords: Biochemistry, Genetics and Molecular Biology;Chemical Engineering;Engineering;Materials Science
Issue Date: 1-Jan-2019
Citation: ASAIO Journal. Vol.65, No.5 (2019), 456-464
Abstract: Copyright © 2018 by the ASAIO. Atrial fibrillation (AF) is a well-established risk factor of thromboembolism (TE). Thromboembolism is one of the most common complications in patients supported by continuousflow left ventricular assisted devices (CF-LVADs). However, the association between AF and TE complications in this population is controversial. We conducted a systematic review and meta-analysis to assess the association between AF and overall TE, stroke, and device thrombosis events in CF-LVAD patients. We performed a comprehensive literature search through September 2017 in the databases of MEDLINE and EMBASE. Included studies were prospective or retrospective cohort studies that compared the risk of developing overall TE, stroke, and device thrombosis events in CF-LVAD patients with AF and those without AF. We calculated pooled risk ratio (RR) with 95% confidence intervals (CI) and I2 statistic using the random-effects model. Eleven studies were included involving 6,351 patients who underwent CF-LVAD implantation. Overall, TE outcome was available in four studies involving 1,106 AF and 3,556 non-AF patients. Stroke outcome was available in seven studies (1,455 AF and 4,037 non-AF patients). Device thrombosis outcome was available in three studies (1,010 AF and 3,327 non-AF patients). There was no association between AF and TE events (RR = 0.95; 95% CI: 0.57-1.59, I2 = 79%, p = 0.85), stroke (RR = 1.10; 95% CI: 0.74-1.64, I2 = 73%, p = 0.65), and device thrombosis (RR = 0.97; 95% CI: 0.56-1.67, I2 = 42%, p = 0.91). AF in CF-LVAD patients was not associated with overall TE, stroke, or device thrombosis events. These findings might be explained by the highly thrombogenic property of CF-LVADs that exceeds the thromboembolic risk driven by AF.
ISSN: 1538943X
Appears in Collections:Scopus 2019

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