Impact of Angiotensin II Inhibitors on the Incidence of Gastrointestinal Bleeds After Left Ventricular Assist Device Placement

Converse, M.; Sobhanian, M.; Mardis, A.; Taber, David J.; Uber, Walter E.; Meadows, Holly B.; Houston, Brian A.; Patel, Neha; VanBakel, Adrian

doi:10.1016/j.healun.2017.01.394

Cited by 3 publications

(4 citation statements)

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“…No dose‐dependent effect in risk reduction for GIB was demonstrated within this analysis. In a similar analysis, however, focusing solely on patients with HMII (2009–2016), a dose‐dependent effect in the prevention of GIB and AVM formation was demonstrated . It is unclear why a dose‐dependent effect was not seen in both studies, but further assessment is warranted.…”

Section: Management Of Gibmentioning

confidence: 92%

“…In a similar analysis, however, focusing solely on patients with HMII (2009-2016), a dose-dependent effect in the prevention of GIB and AVM formation was demonstrated. 40 It is unclear why a dosedependent effect was not seen in both studies, but further assessment is warranted. Although additional multicenter randomized studies should be completed to confirm the true benefit of angiotensin inhibition, especially with respect to secondary prophylaxis, ACEI/ARB therapy remains as widely used heart failure medications in the CF-LVAD patient population.…”

Section: Angiotensin Blockadementioning

confidence: 93%

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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 Gibmentioning

confidence: 92%

Section: Angiotensin Blockadementioning

confidence: 93%

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

et al. 2017

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“…11,13 Incorporation of angiotensin-targeted therapy may mitigate risk for development of AVMs and thus bleeding complications. 37,38 Other pharmacologic agents might be considered such as octreotide, danazol, or thalidomide, with consideration for cost and risk for adverse effects. 39 The current study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

“…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 . Other pharmacologic agents might be considered such as octreotide, danazol, or thalidomide, with consideration for cost and risk for adverse effects …”

Section: Discussionmentioning

confidence: 99%

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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Continuous-Flow Left Ventricular Assist Device–Related Gastrointestinal Bleeding

2018

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Impact of Angiotensin II Inhibitors on the Incidence of Gastrointestinal Bleeds After Left Ventricular Assist Device Placement

Cited by 3 publications

References 0 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

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

Continuous-Flow Left Ventricular Assist Device–Related Gastrointestinal Bleeding

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