Omega-3 Therapy Is Associated With Reduced Gastrointestinal Bleeding in Patients With Continuous-Flow Left Ventricular Assist Device

Abstract

BACKGROUND: Gastrointestinal bleeding (GIB) is a common complication seen in patients supported with left ventricular assist devices (LVADs) and is related to increased inflammation and angiogenesis. Omega-3 is an unsaturated fatty acid that possesses anti-inflammatory and antiangiogenic properties. This study aims to assess the prophylactic efficacy of treatment with omega-3 on the incidence of GIB in LVAD patients. METHODS AND RESULTS: Among consecutive 166 LVAD patients enrolled in this analysis, 30 patients (49 years old and 26 male) received 4 mg/d of omega-3 therapy for 310±87 days and 136 patients in the control group (58 years old and 98 male) were observed for 302±102 days. One-year GIB-free rate was significantly higher in the omega-3 group as compared with the control group (97% versus 73%; P=0.02). Omega-3 therapy was associated with the occurrence of GIB in both the univariate (hazard ratio, 0.12; 95% CI, 0.02–0.91; P=0.040) and multivariate Cox proportional hazard ratio analyses (hazard ratio, 0.13; 95% CI, 0.02–0.98; P=0.047). The frequency of GIB was significantly lower in the omega-3 group (0.08±0.42 versus 0.37±0.93 events/y; P=0.01), accompanied by significantly lower blood product transfusion and shorter days in the hospital. The frequency of GIB remained lower among the omega-3 group after matching for patient background characteristics (96% versus 73%, P=0.028). CONCLUSIONS: LVAD patients treated with omega-3 had a significant increase in freedom from GIB. A randomized controlled study is warranted to evaluate the use of omega-3 in LVAD patients.

Hemocompatibility-related Adverse Events Following HeartMate II Left Ventricular Assist Device Implantation between Japan and United States

“…Our team recently demonstrated that omega-3, one of the unsaturated fatty acids, had a protective effect of gastrointestinal bleeding in LVAD patients. The mechanism likely relates to the suppression of angiopoietin-2 that is located upstream of the angiogenetic signal cascade [13]. However, we could not obtain any dietary data in this study.…”

The “double whammy” of a continuous-flow left ventricular assist device on von Willebrand factor

“…In combination, these observations describe the multifactorial competing mechanisms that create the considerable challenge of managing the balance between nonsurgical bleeding and thrombotic events in CF-LVAD recipients. Improving our understanding of the nuances associated with the physiologic pathways and mechanisms of action that link vWF, pulsatility, and pump shear to clotting disorders, as well as likely contributors to angiodysplasia such as low-molecular-weight vWF multimers 17 and reduced omega-3 fatty acid intake, 18 will help advance the efforts to promote the clinical optimization of CF-LVAD therapies. To provide further information regarding the potential interaction between reduced arterial pulsatility and pump shear, studies looking specifically at vWF or GIB in patients with heart failure implanted with a mechanical circulatory support system were included: LVAD pumps: HeartMate II (Abbott, Chicago, Ill); HeartMate3, HeartWare HVAD (HeartWare Inc, Framingham, Mass), EVAHEART (EVAHEART Inc, Houston, Tex); and 2 total artificial heart devices: CardioWest (SynCardia Systems, Tucson, Ariz) and CARMAT (V elizy-Villacoublay, France).…”

Hemostatic complications associated with ventricular assist devices

“…There are anecdotes about the use of octreotide to control bleeding from arteriovenous malformations, but results are contradictory, and again this should be reserved for patients for whom there are no other options to control bleeding . There are preliminary promising data for omega‐3 fatty acids, where the use of 4 g daily resulted in lower rates of GI bleeding (3%) compared to 22% in a retrospective control group, but these results need to be confirmed in a randomized clinical trial …”