Incidence and Management of Gastrointestinal Bleeding With Continuous Flow Assist Devices

Anticoagulation management of left ventricular assist devices

“…In one study the use of octreotide did not affect red cell transfusion number or rebleeding rates, suggesting that it has little or no impact on outcomes [30]. The use of thalidomide has been suggested based on some success in patients with HHT [31,32], however, the associated thrombotic risk of the drug is concerning for use in patients with LVADs and is not recommended at this time.…”

Challenges in Long-Term Mechanical Circulatory Support and Biological Replacement of the Failing Heart

“…Octreotide has been proposed as a potential therapeutic agent used to decrease the incidence of angiodysplasia-related bleeding, but requires a systematic study to warrant its recommendation. 79 Some data suggest reducing the speed of the VAD to allow for intermittent aortic valve opening and higher pulsatility indices may serve to reduce the frequency of bleeding events. 85 This strategy has also not been proven on a large scale and merits further study.…”

“…Upper GI bleeds are more commonly observed than lower GI bleeds (60% vs. 40%) and one-third of all GI bleeds are caused by angiodysplasia. 78, 79 It is postulated that the high sheer stress on the blood as it flows through the device converts globular multimers of von Willebrand factor (vWF) into elongated proteins subject to proteolysis by the metalloproteinase ADAMTS 13. This phenomenon was first described in the scenario of severe calcific aortic stenosis and is known as Heyde's syndrome.…”

Overview of the Current Benefits and Risks of Continuous-Flow Left Ventricular Assist Devices

“…3,4 In addition, gastrointestinal bleeding while on CF-LVAD support can lead to postimplant readmission and has an overall incidence of approximately 20%. 5 Also, although the smaller CF-LVADs have been associated with a reduced burden of device-related infection, infections still occur at or around the driveline exit site, and complicated device-related infections are one of the leading causes of readmissions in patients supported by CF-LVADs. 6 To address these challenges, Ashrith Guha and colleagues offer an up-to-date review on the prediction, pathophysiology, and management of right ventricular failure after CF-LVAD placement and provide a multidisciplinary management algorithm to address gastrointestinal bleeding in this patient population, while Barry Trachtenberg and colleagues provide an in-depth review on prevention, diagnosis, and management of device-related infections.…”