Treatment of Ventricular Assist-Device-Associated Gastrointestinal Bleeding With Hormonal Therapy

Gutsche, Jacob T.; Atluri, Pavan; Augoustides, John

doi:10.1053/j.jvca.2013.05.019

Cited by 12 publications

(5 citation statements)

References 41 publications

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“…1,4 Case reports have shown improvement in rates of GIB with estrogenbased hormone therapy; however, a randomized, multicenter, controlled trial showed no treatment benefit over placebo. 26,27 Concern for thromboembolism is also to be considered in an already prothrombotic patient cohort. 1,4 Activation of the angiotensin II receptor has been shown to result in angiogenesis through triggering/augmentation of transforming growth factor beta and angiopoietin pathways.…”

Section: Discussionmentioning

confidence: 99%

“…Estrogen‐based hormone therapy has been studied in the LVAD population as well; however, results are conflicting in the few available studies 1,4 . Case reports have shown improvement in rates of GIB with estrogen‐based hormone therapy; however, a randomized, multicenter, controlled trial showed no treatment benefit over placebo 26,27 . Concern for thromboembolism is also to be considered in an already prothrombotic patient cohort 1,4 …”

Section: Discussionmentioning

confidence: 99%

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Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

Inglis,

Asleh,

Iyer

et al. 2023

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BackgroundGastrointestinal bleeding (GIB) in patients with continuous flow left ventricular assist devices (CF‐LVADs) is often related to GI angiodysplasia (GIAD). We previously reported data on VEGF inhibition with IV bevacizumab in the treatment of LVAD‐associated GIAD bleeding, and now present follow‐up data on patients treated with IV bevacizumab and/or low‐dose oral pazopanib.MethodsAll consecutive adult patients with LVAD‐associated GIB from GIAD treated with bevacizumab or pazopanib, from July 20, 2017 to June 22, 2022, were included in the analysis. Data on hospitalizations, GI endoscopic procedures, and blood transfusions were obtained from first admission for GIB up to a median of 35.7 months following treatment initiation (range 1.3–59.8 months).ResultsEleven patients (91% male, mean 69.5 ± 8.9 years) were included. Eight patients (73%) received IV bevacizumab, two patients (18%) received oral pazopanib, and one patient (9%) received bevacizumab followed by pazopanib therapy. We observed a significantly decreased number of annualized hospitalizations for GIB (median difference − 2.87, p = 0.002), blood transfusions (median difference − 20.9, p = 0.01), and endoscopies (median difference − 6.95, p = 0.007) in patients pre‐ and post‐anti‐angiogenic therapy (bevacizumab and/or pazopanib). Similarly, a significant improvement in these clinical outcomes was noted in the bevacizumab group with decreased annualized hospitalizations (median difference − 2.75, p = 0.014), blood transfusions (median difference − 24.5, p = 0.047), and number of endoscopies (median differences −6.88, p = 0.006).ConclusionAnti‐angiogenic therapy with IV bevacizumab and/or low‐dose oral pazopanib appears to provide benefits in patients with LVAD‐associated GIB with reduced hospitalizations, blood transfusions, and need for GI endoscopic procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

Inglis,

Asleh,

Iyer

et al. 2023

Artificial Organs

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“…However, a multicentred, placebo‐controlled, randomized controlled trial in 72 non‐LVAD patients failed to show a significant reduction in bleeding with oestrogen 68 . Data regarding oestrogen‐based hormonal therapy in LVAD patients consist only of case reports 69 . Furthermore, the possible risk of TE events raises major concerns in this patient population.…”

Section: Medical Managementmentioning

confidence: 99%

“…68 Data regarding oestrogen-based hormonal therapy in LVAD patients consist only of case reports. 69 Furthermore, the possible risk of TE events raises major concerns in this patient population.…”

Section: Thalidomidementioning

confidence: 99%

Gastrointestinal bleeding on continuous‐flow left ventricular assist device therapy

2023

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While technological advances in the field of continuous-flow left ventricular assist device (CF-LVAD) are constantly being made, CF-LVAD recipients are still subjected to a relatively high rate of LVAD-related adverse events, with post-LVAD gastrointestinal bleeding (GIB) being the most common one. GIB is associated with a significant impairment in quality of life, multiple hospital admissions, blood transfusion requirements and possibly death. Furthermore, of those patients who bled once, many will experience recurrent GIB events, which further aggravates their discomfort. While some medical and endoscopic treatment options are available, evidence regarding their benefit remains largely equivocal, with all related studies based on data from registries rather than clinical trials. Although having a major impact on LVAD recipients, an effective and validated pre-implant screening options to predict GIB events post-implant are scarce. This review focuses on the aetiology, incidence, risk factors, treatment options and the effect of new generation devices on post-LVAD GIB.

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“…One randomized controlled trial demonstrated that there was no benefit in preventing bleeding recurrence due to GI angiodysplasia 75 . There are, however, case reports of its use in patients with LVADs that have shown remarkable results in reducing frequent GIB 76 . Use of estrogen‐based hormone therapies in patients with LVADs, who are already a prothrombotic population, could increase the risk of thromboembolism.…”

Section: Managementmentioning

confidence: 99%

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

Rio‐Pertuz

Nair

2022

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Background Gastrointestinal bleeding is a major cause of morbidity that plagues the quality of life of patients supported on contemporary continuous‐flow left ventricular assist devices (CF‐LVADs). Despite benefits in survival and the nearly 50% reduction in complications provided by CF‐LVADs, bleeding remains one of the most frequent adverse events with CF‐LVAD implants. The CF‐LVADs cause an increased risk of bleeding mainly due to the activation of the coagulation cascade. Methods A literature search was done using PubMed and Google Scholar from Inception to February 2022. Qualitative analyses of the articles retrieved were used to construct this review. This review attempts to provide a comprehensive summary of the epidemiology, pathophysiology, risk stratification, and management of gastrointestinal bleeding as a complication of CF‐LVAD as well as propose an algorithm for diagnosis and treatment. Results Bleeding can occur at different sites in the gastrointestinal tract, the most common underlying pathology being arteriovenous malformations located in the upper gastrointestinal tract The increased prevalence of gastrointestinal (GI) bleeding in CF‐LVAD patients has been attributed to the physiology of the LVAD itself, the use of anticoagulants, as well as patient comorbidities. Management involves pharmacologic and nonpharmacologic strategies. Conclusions CF‐LVAD‐supported patients have a significant risk of GI bleeding that is mainly caused by arteriovenous malformations located in the upper GI tract. The increased prevalence of GI bleeding in CF‐LVAD patients is attributed to several etiologies that include factors attributed to the device itself and extrinsic factors such as the use of anticoagulation.

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Treatment of Ventricular Assist-Device-Associated Gastrointestinal Bleeding With Hormonal Therapy

Cited by 12 publications

References 41 publications

Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

Inhibition of angiogenesis in the management of refractory gastrointestinal bleeding in patients with LVAD support

Gastrointestinal bleeding on continuous‐flow left ventricular assist device therapy

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

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