Task Force 4: Inpatient Management of Patients with MCSD - The ...

2. Close monitoring of anticoagulation in the setting of an embolic event to assure
adequate levels of anticoagulation is recommended.
Level of Evidence: B.
3. Long-term control of blood pressure is recommended.
Level of Evidence : B.
4. Administration of NIH stroke scale at day 30 and 60 days after a neurologic event is
recommended.
Level of Evidence: C.
5. Resumption of anticoagulation in consultation with neurology in the setting of
hemorrhagic stroke is recommended.
Level of Evidence: C.
Neurocognitive Deficits
The development of and serial assessment for neurocognitive deficits have been
described after coronary artery bypass surgery. 83,84 Neurocognitive deficits can develop
in the setting of advanced heart failure, and they may be exacerbated after MCS. In a
study of 93 patients with a HeartMateII that were serially assessed at 1, 3, and 6
months after implant, there were no declines in any domain of neurocognitive function
and small but significant improvements in visual memory, executive functions, and
visual domains. 85 A separate study of 50 patients with a HeartWare device found
similar results with no significant declines in neurocognitive function from baseline
through 6 months, with some significant improvements in some domains. 86 Assessment
of neurocognitive function after mechanical circulatory support is a part of many clinical
trials, but it is also now a required measure for INTERMACS at 3, 6, 12, and 18 months
post-implant.
Recommendations for Assessment of Neurocognitive Deficits:
Class I:
1. Routine neurocognitive assessment at 3, 6, 12, and 18 months post-implant is
recommended.
Level of Evidence: C.
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