Association of Nasal Mucosal Vascular Alterations, Gastrointestinal Arteriovenous Malformations, and Bleeding in Patients With Continuous-Flow Left Ventricular Assist Devices

Patel, Snehal R.; Madan, Shivank; Saeed, Omar; Algodi, Mohammed; Luke, A.; Gibber, Marc; Goldstein, Daniel J.; Jorde, Ulrich P.

doi:10.1016/j.jchf.2016.08.005

Cited by 60 publications

(34 citation statements)

References 18 publications

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“…We feel for future studies to be of substantive value, this limitation needs to be overcome and thus surrogates of gastrointestinal AVMs must be identified. Whether this is accomplished through evaluation of the nasal mucosa, as we have recently shown (27), or through the microcirculation (24) requires further study.…”

Section: Ang-2 and Avm In Vivomentioning

confidence: 99%

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

Patel¹,

Vukelic²,

Jorde³

2016

J. Thorac. Dis.

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Section: Ang-2 and Avm In Vivomentioning

confidence: 99%

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

Patel¹,

Vukelic²,

Jorde³

2016

J. Thorac. Dis.

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“…Consistently, the prevalence of nasal hypervascularity, which is associated with GIB, in patients with advanced HF was as high as in those with LVAD support. 14 However, the severity of nasal hypervascularity was lower in HF group compared with the LVAD group. LVAD-induced activation of TNF-α would more enhance the angiogenesis cascade.…”

Section: Discussionmentioning

confidence: 89%

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

Imamura

Nguyen

Rodgers

et al. 2018

Circ: Heart Failure

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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.

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“…Furthermore, early intervention may be necessary to optimize outcomes for these patients. Endoscopic intervention may be required as many bleeding events are attributed to AVM formation . Incorporation of angiotensin‐targeted therapy may mitigate risk for development of AVMs and thus bleeding complications .…”

Section: Discussionmentioning

confidence: 99%

“…The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) reported 9.41 bleeding events/100 patient months for 2008‐2011 and 7.79 bleeding events/100 patient months for 2012‐2014 . Various mechanisms are thought to contribute to increased bleeding in these patients, including acquired von Willebrand disease, arteriovenous malformation (AVM), and impaired platelet aggregation . Bleeding might be predicted by certain characteristics such as intent of implant, laboratory parameters, or hemodynamic variables .…”

Section: Introductionmentioning

confidence: 99%

“…arteriovenous malformation (AVM), and impaired platelet aggregation. [6][7][8][9][10][11][12][13][14] Bleeding might be predicted by certain characteristics such as intent of implant, laboratory parameters, or hemodynamic variables. 15,16 In addition, the risk of bleeding may be exacerbated by the use of antithrombotic medications to prevent pump thrombosis, and anticoagulation intensity may be related to the increased rate of hemorrhagic events seen in LVAD recipients.…”

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confidence: 99%

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Evaluation of anticoagulation and nonsurgical major bleeding in recipients of continuous‐flow left ventricular assist devices

et al. 2019

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Continuous‐flow left ventricular assist device (LVAD) placement has become a standard of care in advanced heart failure treatment. Bleeding is the most frequently reported adverse event after LVAD implantation and may be increased by antithrombotic agents used for prevention of pump thrombosis. This retrospective cohort included 85 adult patients implanted with a Heartmate II LVAD. Major bleeding was defined as occurring >7 days after implant and included intracranial hemorrhage, events requiring 2 units of packed red blood cells within a 24‐h period, and death from bleeding. Primary outcome was intensity of anticoagulation between patients with or without at least one incidence of nonsurgical major bleeding. Major bleeding occurred in 35 (41%) patients with 0.48 events per patient year and a median (IQR) time to first bleed of 134.5 (39.3, 368.5) days. The median (IQR) INR at time of bleed was 1.7 (1.4, 2.5). Median INR during follow‐up did not differ between groups and patients with major bleeding were not more likely to have a supra‐therapeutic INR. Patients who bled were more likely to have received LVAD for destination therapy, to have lower weight, worse renal function, and lower hemoglobin at baseline. Duration of LVAD support and survival were similar between groups with no difference in occurrence of thrombosis. Incidence of nonsurgical major bleeding was not significantly associated with degree of anticoagulation. Certain baseline characteristics may be more important than anticoagulation intensity to identify patients at risk for bleeding after LVAD implant. Modification of anticoagulation alone is not a sufficient management strategy and early intervention may be required to mitigate bleeding impact.

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Association of Nasal Mucosal Vascular Alterations, Gastrointestinal Arteriovenous Malformations, and Bleeding in Patients With Continuous-Flow Left Ventricular Assist Devices

Cited by 60 publications

References 18 publications

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

Bleeding in continuous flow left ventricular assist device recipients: an acquired vasculopathy?

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

Evaluation of anticoagulation and nonsurgical major bleeding in recipients of continuous‐flow left ventricular assist devices

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