Novel Use of Thalidomide in Recurrent Gastrointestinal Tract Bleeding in Patients with Left Ventricular Assist Devices: A Case Series

Chan, Laura; Lim, Choon Pin; Lim, Chong Hee; Tan, Teing Ee; Sim, David; Sivathasan, Cumaraswamy

doi:10.1016/j.hlc.2016.11.017

Cited by 17 publications

(10 citation statements)

References 20 publications

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“…Prospective, randomized, and larger studies are underway to confirm these results (NCT01707225). Thalidomide and danazol also seem to decrease recurrent bleeding, 25–28 to be confirmed by prospective and larger studies. Recently, a pilot study reported a significant reduction of blood transfusions, bleeding‐related hospitalizations, and endoscopy procedures in LVAD's patients with refractory GI angiodysplasia related bleeding after intravenous infusion of a humanized monoclonal antibody against VEGF (bevacizumab Avastin) 29 .…”

Section: Discussionmentioning

confidence: 76%

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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Section: Discussionmentioning

confidence: 76%

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

et al. 2022

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“…Following commencement of therapy, patients are monitored on a regular basis for development of thalidomide-related adverse effects. The safety and efficacy of thalidomide in our first patients provided us with the confidence to continue the therapy in further patients presenting with recurrent GIB (11).…”

Section: Discussionmentioning

confidence: 90%

Novel Use of Low-dose Thalidomide in Refractory Gastrointestinal Bleeding in Left Ventricular Assist Device Patients

et al. 2017

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“…Therefore, it is unclear whether these results could be applied to other patient populations with significant comorbidities. Three previous case series of patients with an LVAD[ 13 ] and one case study of patients with liver cirrhosis[ 17 ] found thalidomide effective in treating refractory GIB patients with these comorbidities. The response rate in our study was 84.6%, comparable to other previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Given that patients with recurrent GIB from GIVM are frequently elderly with several comorbidities, it is unclear whether the results of this study can be extrapolated to other patient populations. Whereas there are several reported case series on the effects of thalidomide on patient with cirrhosis or LVAD[ 13 , 20 - 22 ], many other studies excluded patients with significant comorbidities (Table 1 ). We therefore decided to conduct a retrospective study of thalidomide in treating refractory GIB from GIVM in a Western population with significant comorbidities at a tertiary medical center.…”

Section: Introductionmentioning

confidence: 99%

Thalidomide for refractory gastrointestinal bleeding from vascular malformations in patients with significant comorbidities

Bayudan¹,

Chen²

2020

WJCC

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BACKGROUND Refractory gastrointestinal bleeding (GIB) secondary to gastrointestinal vascular malformations (GIVM) such as gastrointestinal angiodysplasia (GIAD) and gastric antral vascular ectasia (GAVE) remains challenging to treat when endoscopic therapy fails. Recently thalidomide has been suggested as a treatment option for refractory GIB. AIM To determine the outcome of patients treated with thalidomide for refractory GIB due to GIVM. METHODS IRB approved, single center, retrospective review of electronic medical records from January 2012 to November 2018. Patients age > 18 years old, who had > 3 episodes of GIB refractory to medical or endoscopic therapy, and who had been treated with thalidomide for at least 3 mo were included. The primary endpoint was recurrence of GIB 6 mo after initiation of thalidomide. RESULTS Fifteen patients were included in the study, all with significant cardiac, hepatic, or renal comorbidities. The cause of GIB was GIAD in 10 patients and GAVE in 5 patients. Two patients were lost to follow up. Of the 13 patients followed, 38.5% ( n = 5) had no recurrent GIB or transfusion requirement after treatment with thalidomide. Furthermore, 84.6% ( n = 11) of patients had a reduction in transfusion requirements and hospitalizations for GIB. Thalidomide was discontinued in 2 patients due to cost ( n = 1) and medication interaction ( n = 1). Reported adverse reactions included fatigue ( n = 3), neuropathy ( n = 2), dizziness ( n = 1), and constipation ( n = 1). Six patients died during follow up due to unknown cause ( n = 4) and sepsis ( n = 2). CONCLUSION Thalidomide appears to be an effective treatment for refractory GIB due to GIAD or GAVE in a Western population with significant comorbidities.

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Novel Use of Thalidomide in Recurrent Gastrointestinal Tract Bleeding in Patients with Left Ventricular Assist Devices: A Case Series

Cited by 17 publications

References 20 publications

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

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

Novel Use of Low-dose Thalidomide in Refractory Gastrointestinal Bleeding in Left Ventricular Assist Device Patients

Thalidomide for refractory gastrointestinal bleeding from vascular malformations in patients with significant comorbidities

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