Octreotide for the Management of Gastrointestinal Bleeding in a Patient with a HeartWare Left Ventricular Assist Device

Dang, Geetanjali; Grayburn, Ryan; Lamb, Geoffrey C.; Reguero, Adrian Umpierrez De; Gaglianello, Nunzio

doi:10.1155/2014/826453

Cited by 10 publications

(10 citation statements)

References 8 publications

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“…He remained free from bleeding for 6 months. A similar case report was published in 2014 describing a 56‐year‐old woman who underwent HeartWare implantation and experienced recurrent GIB . After reduction in pump speed and decreasing antithrombotic therapies, subcutaneous octreotide 100 μg twice/day was successful for 3 weeks.…”

Section: Management Of Gibsupporting

confidence: 63%

“…A similar case report was published in 2014 describing a 56-year-old woman who underwent HeartWare implantation and experienced recurrent GIB. 42 After reduction in pump speed and decreasing antithrombotic therapies, subcutaneous octreotide 100 lg twice/day was successful for 3 weeks. The patient was then readmitted, had several AVMs and erosions ablated, and was subsequently restarted on subcutaneous octreotide.…”

Section: Octreotidementioning

confidence: 99%

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Pharmacotherapeutic Management of Gastrointestinal Bleeding in Patients with Continuous‐Flow Left Ventricular Assist Devices

et al. 2017

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Continuous-flow left ventricular assist devices (CF-LVADs) have become an integral component of the management in patients with advanced heart failure, serving as destination therapy or as a bridge to heart transplantation. Despite significant advances in the design and longevity of the device, the ongoing risk for bleeding remains a significant concern. The genesis of gastrointestinal bleeding (GIB) in patients with CF-LVADs is likely multifactorial and may include components of acquired von Willebrand disease, angiodysplasia, and gastrointestinal arteriovenous malformations, as well as additional risk factors such as history of GIB and increased age. Several pharmacotherapy options have been used, but the data surrounding their overall efficacy remain sparse. The necessity for larger prospective studies is essential to further advance the management of this devastating complication. Within this review, we discuss the known pathophysiologic process of CF-LVAD-related GIB and highlight the therapeutic options discussed within the literature. In addition, we discuss potential therapeutic options based on mechanisms of action as they correlate to known pathophysiologic processes of CF-LVAD-related GIB. Finally, we provide recommendations for constructing drug therapy regimens in patients with CF-LVADs who develop GIB.

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Section: Management Of Gibsupporting

confidence: 63%

Section: Octreotidementioning

confidence: 99%

Pharmacotherapeutic Management of Gastrointestinal Bleeding in Patients with Continuous‐Flow Left Ventricular Assist Devices

et al. 2017

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“…(Table 2) Octreotide, a somatostatin analogue involved in decreased acid secretion/splanchnic flow, inhibition of angiogenesis and platelet aggregation, has been shown to stabilize GI bleeding in patients with LVADs in multiple case reports. [43][44-46] However, in larger case series, octreotide did not appear to significantly impact the rate of recurrent GI bleeding or decrease the need for transfusion. [8, 47].…”

Section: Resultsmentioning

confidence: 99%

Gastrointestinal Bleeding Following LVAD Placement from Top to Bottom

Cushing

Kushnir

2016

Dig Dis Sci

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Left ventricular assist devices (LVADs) are an increasingly prevalent form of mechanical support for patients with end-stage heart failure. These devices can be implanted both as a bridge to transplant or definitive/destination therapy. Gastrointestinal (GI) bleeding is one of the most common and recalcitrant long-term complications following LVAD implantation, with an incidence approaching 30%. The pathophysiology of bleeding is multifactorial, with hemodynamic alterations, acquired von Willebrand factor deficiency, and coagulopathy being most often implicated. The majority of bleeding events in this population result from angioectasias and gastro-duodenal erosive disease. While these bleeding events are significant and often require transfusion therapy, they are rarely life threatening. Endoscopy remains the standard of care with upper endoscopy offering the highest diagnostic yield in these patients. However, the effectiveness of endoscopic hemostasis in this population is not well established. A small number of studies have evaluated medical therapy and alterations in LVAD settings as a means of preventing or treating bleeding with variable results. In summary, GI bleeding with LVADs is a common occurrence and will continue to be as more LVADs are being performed for destination therapy. This review will discuss what is known about the pathophysiology of GI bleeding in LVADs and the currently available options for medical and/or endoscopic management.

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“…Invasive management was rarely performed (20%) because the bleeding source remained largely unknown and if a lesion is found, invasive management is not always possible. New therapeutic approaches are emerging mainly in secondary prevention such as octreotide, a molecule well‐known by gastroenterologists, with satisfactory results on recurrent GI bleeding 22–24 . Prospective, randomized, and larger studies are underway to confirm these results (NCT01707225).…”

Section: Discussionmentioning

confidence: 99%

Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients

et al. 2022

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Aims Left ventricular assist devices (LVADs) have reduced the mortality of patients with advanced heart failure both as bridge-to-transplant and as destination therapy. However, LVADs are associated with various complications, including bleedings, which affect the prognosis. The aim of the study was to explore the prevalence, management, and outcomes of haemorrhagic adverse events in LVAD recipients. Methods and resultsWe conducted a retrospective, single-centre, cohort study including all patients who received an LVAD from January 2008 to December 2019 in our tertiary centre (Rangueil University Hospital, Toulouse, France). Bleeding events, death, and heart transplantation were collected from electronic medical files. Eighty-eight patients were included, and 43 (49%) presented at least one bleeding event. Gastrointestinal (GI) bleeding was the most frequent (n = 21, 24%), followed by epistaxis (n = 12, 14%) and intracranial haemorrhage (n = 9, 10%). Bleeding events were associated with increased mortality [hazard ratio (HR) 3.8, 95% confidence interval (CI) 1.5-9.3, P < 0.01], particularly in case of intracranial haemorrhage (HR 14.6, 95% CI 4.2-51.1, P < 0.0001). GI bleedings were associated with a trend towards increased mortality (HR 3.0, 95% CI 0.9-9.3, P = 0.05). Each bleeding episode multiplied the risk of death by 1.8 (95% CI 1.2-2.7, P < 0.01). Finally, only early bleedings (<9 months post-implantation) had an impact on mortality (HR 4.2, 95% CI 1.6-11.1, P < 0.01). Therapeutic management was mainly based on temporary interruption of anticoagulation and permanent interruption of antiplatelet therapy. Invasive management was rarely performed. Conclusions Haemorrhagic events in LVAD recipients are frequent and associated with increased mortality. GI bleedings are the most frequent, and intracranial haemorrhages the most associated with mortality. Management remains empirical requiring more research.

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Octreotide for the Management of Gastrointestinal Bleeding in a Patient with a HeartWare Left Ventricular Assist Device

Cited by 10 publications

References 8 publications

Pharmacotherapeutic Management of Gastrointestinal Bleeding in Patients with Continuous‐Flow Left Ventricular Assist Devices

Pharmacotherapeutic Management of Gastrointestinal Bleeding in Patients with Continuous‐Flow Left Ventricular Assist Devices

Gastrointestinal Bleeding Following LVAD Placement from Top to Bottom

Prevalence, management, and outcomes of haemorrhagic events in left ventricular assist device recipients

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