Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices

Plazak, Michael E; Hankinson, Stephen J.; Sorensen, Erik N.; Reed, Brent N.; Ravichandran, Bharath; Ton, Van-Khue

doi:10.1007/s12265-020-10084-7

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…In a case series of 8 patients with a Heartware HVAD (Medtronic), the authors reported on the use of tamoxifen to reduce major gastrointestinal bleeding. 82 Tamoxifen has been used to treat hereditary telangiectasia and is thought to modulate (upregulate) transforming growth factor-beta signaling, which reduces abnormal angiogenesis and potentially augments vascular repair. Tamoxifen also may reduce vascular endothelial growth factor release from platelets.…”

Section: Ventricular Assist Devicesmentioning

confidence: 99%

Coagulation and Transfusion Updates From 2021

Fabbro

Patel

Henderson

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Ventricular Assist Devicesmentioning

confidence: 99%

Coagulation and Transfusion Updates From 2021

Fabbro

Patel

Henderson

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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“…A common first step in practice to reduce GIB risk is the discontinuation of aspirin followed by lowering INR goals, or in some cases, a combination of INR target range adjustment and addition of secondary prophylaxis medications are implemented. Secondary prophylaxis medications such as renin angiotensin aldosterone system (RAAS) inhibitors, octreotide, desmopressin, thalidomide, danazol, and recently tamoxifen now have studies suggesting some efficacy in reducing GIB reoccurrence rates in LVAD patients 11–13 . This retrospective study aims to describe efficacy and safety outcomes regarding secondary GIB prophylaxis strategies with lower INR target ranges compared to lower INR target ranges plus hemostatic agents on GIB reoccurrence rates after aspirin discontinuation.…”

Section: Introductionmentioning

confidence: 99%

“…Secondary prophylaxis medications such as renin angiotensin aldosterone system (RAAS) inhibitors, octreotide, desmopressin, thalidomide, danazol, and recently tamoxifen now have studies suggesting some efficacy in reducing GIB reoccurrence rates in LVAD patients. [11][12][13] This retrospective study aims to describe efficacy and safety outcomes regarding secondary GIB prophylaxis strategies with lower INR target ranges compared to lower INR target ranges plus hemostatic agents on GIB reoccurrence rates after aspirin discontinuation.…”

Section: Introductionmentioning

confidence: 99%

Retrospective review of secondary prevention strategies for gastrointestinal bleeding and associated clinical outcomes in left ventricular assist device patients

et al. 2022

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Background Gastrointestinal bleeding (GIB) is one of the most common bleeding complications associated with left ventricular assist devices (LVAD). Currently, there is no strong evidence or clear guidance for which secondary GIB prophylaxis strategy should be implemented after the discontinuation of aspirin. Methods Our single‐center study describes the outcomes of 26 LVAD patients who experienced a total of 49 GIB events: these individuals were either in Group‐1 (lower INR target range) or Group‐2 (lower INR target plus a hemostatic agent) as the secondary prophylaxis strategy. Each GIB event was considered an independent event. Outcomes assessed were bleeding reoccurrence rates, time to next GIB, acute GIB strategies, GIB‐free days, thromboembolic events, survival, coagulation, and hematologic parameters. Results GIB reoccurrence rates were not statistically different: Group‐1, 9 (40.9%), versus Group‐2, 15 (55.6%); p = 0.308. Danazol was utilized 81.5% of the time as the designated hemostatic agent. Additionally, no significant differences were observed with all of our secondary outcome measures for bleeding, ischemic events, or survival. Conclusion While our study was not powered to assess the clinical outcomes related to survival and thromboembolic events, no discernable increased risk for ischemic events including pump thrombosis were observed. Our data suggest that a lower INR target range plus danazol does not confer any additional benefit over a lower INR target range only approach. The results of this report are hypothesis‐generating and additional studies are warranted to elucidate the optimal antithrombotic strategy and role of hemostatic agents in reducing the risk of recurrent GIB events.

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LVAD‐Associated Acquired von Willebrand Syndrome and Gastrointestinal Bleeding: Pathophysiology, Etiologies, and Management

Ramdeen,

Bartoli

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices

Cited by 4 publications

References 31 publications

Coagulation and Transfusion Updates From 2021

Coagulation and Transfusion Updates From 2021

Retrospective review of secondary prevention strategies for gastrointestinal bleeding and associated clinical outcomes in left ventricular assist device patients

LVAD‐Associated Acquired von Willebrand Syndrome and Gastrointestinal Bleeding: Pathophysiology, Etiologies, and Management

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