Features of Patients With Gastrointestinal Bleeding After Implantation of Ventricular Assist Devices

Singh, Gurshawn; Albeldawi, Mazen; Kalra, Saminder; Mehta, Paresh P.; López, Rocío; Vargo, John J.

doi:10.1016/j.cgh.2014.05.012

Cited by 34 publications

(12 citation statements)

References 18 publications

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“…We report a 41.7 % incidence of GIB after LVAD implantation, with the majority of the episodes occurring in the upper gastrointestinal tract, irrespective of GIAD or a non-GIAD source (65 % & 55 %). We diagnosed GIAD in 41 % of bleeding episode, which is similar to the published literature, and the majority of GIAD events were found in the upper gastrointestinal tract (65 %) 12 13 14 . Bleeding episodes secondary to GIAD required an average of 8 units of PRBC whereas non-GIAD bleeding episodes required an average 3 units of PRBC.…”

Section: Discussionsupporting

confidence: 86%

Gastrointestinal angiodysplasia is associated with significant gastrointestinal bleeding in patients with continuous left ventricular assist devices

Cochrane

Jackson

Schlepp³

et al. 2016

Endosc Int Open

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Background and study aims: Patients with a continuous-flow left ventricular assist device (LVAD) have a 65 % incidence of bleeding events within the first year. The majority of gastrointestinal bleeding (GIB) is from gastrointestinal angiodyplasia (GIAD). The primary aim of the study was to determine whether GIAD was associated with a higher rate of significant bleeding, an increased number of bleeding events per year, and a higher rate of transfusion compared to non-GIAD sources. Patients and methods: This retrospective cohort study included 118 individuals who received a LVAD at a tertiary medical center from 2006 through 2014. Patients were subdivided into GIB and non-GIB for comparison of patient demographics, comorbid conditions, and laboratory data. GIB was further divided into sources of GIB, GIAD, obscure, or non-GIAD to establish severity of bleeding, rate of re-bleeding, and transfusion rate. Results: GIAD is associated with an increased number of bleeding events compared to non-GIAD sources of GIB (2.07 vs 1.23, P = 0.01) and a higher number of bleeding events per year (0.806 vs. 0.455 P = 0.001). GIAD compared to non-GIAD sources of GIB was associated with an increased incidence of major bleeding (100 % vs 60 %, P = 0.006) and increased rates of transfusion (8.8 vs 2.95 units, P = 0.0004). Cox Regression analysis between non-GIB and GIAD demonstrated increased risk with age (P = 0.001), history of chronic kidney disease (P = 0.005), and length of stay after LVAD implantation of more than 45 days (P = 0.04). History of hypertension (P = 0.045), diabetes mellitus (P = 0.016), and male gender was associated with decreased risk (P = 0.04). Conclusion: Patients with a continuous-flow LVAD who develop a GIB secondary to GIAD have a higher rate of major bleeding, multiple bleeding events, and require more transfusions to achieve stabilization compared to patients who do not have GIAD.

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Section: Discussionsupporting

confidence: 86%

Gastrointestinal angiodysplasia is associated with significant gastrointestinal bleeding in patients with continuous left ventricular assist devices

Cochrane

Jackson

Schlepp³

et al. 2016

Endosc Int Open

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“…GIB was defined as overt or occult bleeding within the gastrointestinal tract that occurred during a period of antiplatelet therapy [18]. An overt bleed was classified as melena, hematochezia, hematemesis, and coffee ground emesis.…”

Section: Definitionsmentioning

confidence: 99%

Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients

Wan

Zhou

Liu

et al. 2018

Cell Physiol Biochem

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Background/Aims: Bleeding complications after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes. However, there are no specific guidelines for the predictors and management of antiplatelet-related bleeding complications in Chinese elderly patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of 237 consecutive patients (aged ≥ 75 years) with ACS who had undergone successful PCI from January 2010 to December 2016 was performed to identify predictors and management of antiplatelet-related bleeding complications. Multivariate logistic regression analysis was conducted to investigate independent predictors of antiplatelet-related bleeding complications. We defined antiplatelet-related bleeding complications as first hospitalization received long-term oral antiplatelet therapy and required hospitalization, including gastrointestinal and intracranial bleedings. Results: After multivariable adjustment, independent risk predictors of antiplatelet-related bleeding complications included female gender (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.98 to 4.15; P = 0.011), body mass index (OR: 1.54; 95% CI: 1.06 to 1.94; P = 0.034), previous history of bleeding (OR: 4.03; 95% CI: 1.84 to 6.12; P = 0.004), fasting blood glucose (OR: 2.79; 95% CI: 1.23 to 4.46; P = 0.025), and chronic total occlusion lesion (OR: 4.69; 95% CI: 2.19 to 7.93; P = 0.007). Of 46 patients with antiplatelet-related bleeding complications, 54.3% were treated short-term dual antiplatelet therapy (DAPT) cessation (0–7 days) and 45.7% underwent long-term DAPT cessation (> 7 days). Among these, 14 patients presented major adverse cardiac and cerebrovascular events (MACCE), whereas no re-bleeding happened over all available follow-up. The incidence of MACCE was not significantly different between the two groups one year after PCI (36.0% for short-term DAPT cessation versus 23.8% for long-term DAPT cessation, P = 0.522). Conclusion: For elderly patients with ACS, multiple factors were likely to contribute to antiplatelet-related bleeding complications, especially previous history of bleeding and chronic total occlusion lesion. Better individualized, tailored and risk-adjusted antiplatelet therapy after PCI is urgently needed in this high-risk population.

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“…The reason for eventually reduced bleeding could also be the reduced shear stress due to reduced speed or the different flow distribution between pump flow and direct flow through the aortic valve. A greater GIB rate in rotary pump recipients than in pulsatile VAD recipients has indeed been reported by several groups [37][38][39][40]. However, up to now no clinical setting could differentiate between reduced pulsatility due to rotary pumps and the degradation of vWF.…”

Section: Gastrointestinal Bleeding and Coagulation Disturbancesmentioning

confidence: 83%

Debate

Schima

Dimitrov²,

Zimpfer³

2016

Current Opinion in Cardiology

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Features of Patients With Gastrointestinal Bleeding After Implantation of Ventricular Assist Devices

Cited by 34 publications

References 18 publications

Gastrointestinal angiodysplasia is associated with significant gastrointestinal bleeding in patients with continuous left ventricular assist devices

Gastrointestinal angiodysplasia is associated with significant gastrointestinal bleeding in patients with continuous left ventricular assist devices

Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients

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