Gastrointestinal Bleeding in Left Ventricular Assist Device: Octreotide and Other Treatment Modalities

Molina, T.L.; Krisl, Jill C.; Donahue, Kevin; Varnado, Sara

doi:10.1097/mat.0000000000000758

Cited by 34 publications

(33 citation statements)

References 63 publications

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“…94 Despite the fact that, through the antiangiogenic pathway, thalidomide and atorvastatin reduce the rate of bleeding from arterio venous malformations and the transfusion need in VWD patients, these have only been used sporadically in LVAD patients. 95 Large prospective, randomized trials should be performed to define its role in preventing LVAD-associated bleeding complications. In addition, these agents are not registered for use in LVAD patients.…”

Section: How Do We Manage Bleeding In Patients With Lvads?mentioning

confidence: 99%

Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management

Leebeek¹,

Muslem

2019

Hematology

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Chronic heart failure (HF) is a growing health problem, and it is associated with high morbidity and mortality. Left ventricular assist devices (LVADs) are nowadays an important treatment option for patients with end-stage HF not only as a bridging tool to heart transplantation but also, as a permanent therapy for end-stage HF (destination therapy). The use of LVAD is associated with a high risk for bleeding complications and thromboembolic events, including pump thrombosis and ischemic stroke. Bleeding is the most frequent complication, occurring in 30% to 60% of patients, both early and late after LVAD implantation. Although the design of LVADs has improved over time, bleeding complications are still the most common complication and occur very frequently. The introduction of an LVAD results in an altered hemostatic balance as a consequence of blood-pump interactions, changes in hemodynamics, acquired coagulation abnormalities, and the strict need for long-term anticoagulant treatment with oral anticoagulants and antiplatelet therapy. LVAD patients may experience an acquired coagulopathy, including platelet dysfunction and impaired von Willebrand factor activity, resulting in acquired von Willebrand syndrome. In this educational manuscript, the epidemiology, etiology, and pathophysiology of bleeding in patients with LVAD will be discussed. Because hematologist are frequently consulted in cases of bleeding problems in these individuals in a critical care setting, the observed type of bleeding complications and management strategies to treat bleeding are also reviewed.

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Section: How Do We Manage Bleeding In Patients With Lvads?mentioning

confidence: 99%

Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management

Leebeek¹,

Muslem

2019

Hematology

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“…Interestingly, GIB tended to have a lower mortality at 1 year and this may reflect that more frequent hospitalizations increased medical optimization, which is lost over time. There has been a shift in focus on medical management on this unique population of patients [ 32 ]. There were 4 patients in our study population treated with octreotide for rGIB.…”

Section: Discussionmentioning

confidence: 99%

Initial endoscopic intervention is not associated with reduced risk of recurrent gastrointestinal bleeding in left ventricular assist device patients

Stern

Maheshwari

Gorrepati

et al. 2021

aog

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Background Left ventricular assist devices (LVADs) are increasingly used for mechanical support of end-stage heart failure. Gastrointestinal bleeding (GIB) confers a significant morbidity in LVAD patients, with rates of up to 30% at 5 years. We assessed predictors of index and recurrent GIB (rGIB) in LVAD patients to risk stratify patients and evaluate if endoscopic approach and intervention at index GIB impacted rGIB. Methods A retrospective chart review of all LVAD patients at our institution from 01/01/2006 to 31/10/2016 was completed. Predictors for index and recurrent GIB were analyzed. Multivariate logistic regression analysis was created using only statistically significant dependent variables and adjusted for demographic variables. Results A total of 77/214 (36%) patients developed GIB, and 38/214 (17.8%) developed rGIB. Destination therapy (P=0.01), longer duration of LVAD (P=0.03), and low albumin (<3.5 g/dL) (P<0.001) were associated with increased risk of index GIB. Charlson Comorbidity Index, heart failure etiology, and Medicare were predictors of index GIB on univariate analysis, but this was not seen on multivariate analysis. Performing an endoscopy with/without intervention, non- angioectasia lesions, and location of bleeding were not statistically significant predictors of rGIB. Longer duration of hospitalization appeared to be protective for rGIB on univariate analysis. Conclusions Index endoscopy and intervention is not associated with reduced risk of rGIB in LVAD patients. Several independent factors are associated with the risk of index GIB. Albumin is a potentially modifiable risk factor, and likely contributes to bleeding through poor nutrition. It is a surrogate marker for systemic illness, and may have pharmacologic implications.

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“…6 Alternatively, while subcutaneous octreotide administration requires multiple daily injections, octreotide long-acting release, an intramuscular injection, slowly releases octreotide and is injected every 4 weeks, reaching a steady-state after three injections. 8 This dosage technique may improve medication compliance and therapeutic effectiveness. Additionally, the side effects of octreotide longacting release are tolerable with minimal impairment.…”

Section: Discussionmentioning

confidence: 99%

Successful use of long-acting octreotide for protracted gastrointestinal bleeding related to protein-losing enteropathy after the Fontan procedure: a case report

2021

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Gastrointestinal bleeding complicated with protein-losing enteropathy after the Fontan procedure has been often reported in recent years, but there is no established therapy for it. We report the case of an 18-year-old boy who suffered from abdominal pain, melena, and anaemia due to intractable haemorrhagic protein-losing enteropathy after the Fontan procedure. He was successfully treated with octreotide therapy.

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Gastrointestinal Bleeding in Left Ventricular Assist Device: Octreotide and Other Treatment Modalities

Cited by 34 publications

References 63 publications

Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management

Bleeding in critical care associated with left ventricular assist devices: pathophysiology, symptoms, and management

Initial endoscopic intervention is not associated with reduced risk of recurrent gastrointestinal bleeding in left ventricular assist device patients

Successful use of long-acting octreotide for protracted gastrointestinal bleeding related to protein-losing enteropathy after the Fontan procedure: a case report

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