Gastrointestinal Bleeding Rates in Left Ventricular Assist Device Population Reduced with Octreotide Utilization

Abstract

Patients with continuous-flow left ventricular assist devices have a high risk of gastrointestinal bleeding (GIB) and recurrent bleeding. Studies have shown octreotide can reduce the risk of GIB. This retrospective, case-crossover study, evaluated the efficacy of octreotide for the prevention of recurrent GIB in patients with left ventricular assist devices between August 2008 and October 2018. A total of 32 patients received octreotide and were included in the study. Hospital admission for GIB was evaluated before and after the initiation of octreotide. Each case served as his/her own control. Most patients were on a reduced aspirin dose (56.2%) and had a reduced international normalized ratio goal (59.4%) before starting monthly octreotide. The most common dose of long-acting octreotide was 30 mg every 28 days. Overall, octreotide decreased the frequency of GIB (4.3 vs. 0.9 events/year, p < 0.001). Nineteen (59.4%) patients did not have a subsequent gastrointestinal bleed. Of the 13 patients who rebled after initiation of octreotide, the frequency of events decreased by 2.6 bleeds per patient per year (4.8 vs. 2.2; p = 0.043). In high-risk patients who have failed conventional therapy, octreotide can be useful for the prevention of recurrent GIB.

Gastrointestinal bleeding in patients with continuous‐flow left ventricular assist devices: A comprehensive review

“…The main limitation of that study was that there was no comparison population who did not receive octreotide. A retrospective cross‐over study of 32 patients that demonstrated the use of monthly subcutaneous octreotide (30 mg every 28 days) decreased the frequency of recurrent GIB (4.3 vs. 0.9 events per year, p < 0.01), 55 this was the first study that evaluated the use of octreotide in HeartMate III. Despite the different limitations of current studies, octreotide is currently considered a first‐line agent.…”

“…Although no large studies are presently published, a small number of retrospective, case series, and reports have described the use of octreotide in various formulations (50–100 μg subcutaneous twice daily or octreotide long‐acting release 20–30 mg intramuscularly monthly) noting the prevention and treatment of LVAD‐associated GIB and have demonstrated beneficial effects. In Table 1, we list some of the recent studies that describe the use of octreotide 41,55–59 . In regard to primary prevention of GI bleeding, the case series by Malhotra et al evaluated the safety and tolerability of octreotide acetate 20 mg long‐acting release depot injection every 4 weeks until week 16 after LVAD placement 58 .…”

“…In Table 1, we list some of the recent studies that describe the use of octreotide. 41,[55][56][57][58][59] In regard to primary prevention of GI bleeding, the case series by Malhotra et al evaluated the safety and tolerability of octreotide acetate 20 mg long-acting release depot injection every 4 weeks until week 16 after LVAD placement. 58 Of the 10 patients enrolled, only 8 finished the 28 weeks follow-up.…”

Gastrointestinal bleeding during the transcatheter aortic valve replacement perioperative period: A Review

“…The frequency of bleeding events for the other 13 patients was 2.6 per patient per year, which was significantly lower than the historical level. [65] Similar to the pathophysiology of patients using LVAD, the risk factors for an increased likelihood of GI bleeding for patients with severe AVS include the loss of VWF secondary to high shear rate, application of antiplatelet and anticoagulant agents, angiodysplasia in the GI tract, and intestinal hypoperfusion. Therefore, octreotide is also considered suitable for AVS patients.…”

“…The frequency of bleeding events for the other 13 patients was 2.6 per patient per year, which was significantly lower than the historical level. [65]…”