Long-Acting Octreotide Reduces the Recurrence of Gastrointestinal Bleeding in Patients With a Continuous-Flow Left Ventricular Assist Device

Abstract

Background Recurrent gastrointestinal bleeding is one of the most significant adverse events in patients with left ventricular assist devices (LVAD). Methods We enrolled LVAD patients who had received an intramuscular injection of 20 mg of octreotide LR every 4 weeks as secondary prevention for recurrent gastrointestinal bleeding despite conventional medical therapies and repeated transfusions. The frequency of gastrointestinal bleeding and other associated clinical outcomes before and during octreotide therapy were compared. Results Thirty LVAD patients (66.4 ± 8.8 years old and 16 male [53%]) received octreotide therapy for 498.8 ± 356.0 days without any octreotide-associated adverse events. The frequency of gastrointestinal bleeding was decreased significantly during octreotide therapy (from 3.4 ± 3.1 to 0.7 ± 1.3 events/year, p <0.001), accompanied by significant reductions in red blood cell and flesh frozen plasma transfusions, days in hospital, and need for endoscopic procedures (p <0.05 for all). Conclusions Octreotide therapy reduced the frequency of recurrent gastrointestinal bleeding and may be considered for secondary prevention.

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

“…11,20 Other therapies, such as danazol and thalidomide, have recently been proposed for the management of GIB. 21,22 However, their clinical use may be restricted to the secondary prevention of GIB, considering their significant adverse effect profiles.…”

“…In cases of recurrent bleeding, patients were started on long-acting octreotide as an outpatient, 11 and in select cases, the INR target was reduced.…”

Characteristics and outcomes of gastrointestinal bleeding in patients with continuous‐flow left ventricular assist devices: A systematic review

“…Several strategies have been suggested for preventing and reducing gastrointestinal bleeding, which may increase the amount of uninterrupted therapy with warfarin and aspirin, and decrease thromboembolic events. Octreotide injections can help to prevent re‐bleeding, which may allow for warfarin and aspirin to be given continuously following the index gastrointestinal bleed 26 . Also, routine therapy with an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) has been shown to reduce GIB by 57% 42 .…”

Implication of Hemodynamic Assessment during Durable Left Ventricular Assist Device Support

“…Bleeding, particularly gastrointestinal bleeding, is among the most common comorbidities during LVAD support with an estimated incidence of 25% [24]. Some gastrointestinal bleeding events are refractory to all available therapeutic strategies including octreotide, danazol, and thalidomide in addition to the termination of antiplatelet and anticoagulation therapies [25].…”