Risk Factors and Outcomes of Gastrointestinal Bleeding in Left Ventricular Assist Device Recipients

Joy, Parijat S.; Kumar, Gagan; Guddati, Achuta Kumar; Bhama, Jay K.; Cadaret, Linda

doi:10.1016/j.amjcard.2015.10.041

Cited by 63 publications

(48 citation statements)

References 18 publications

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“…This is comparable to the contemporary incidence of gastrointestinal hemorrhage of approximately 10% per year 18 and of pump thrombosis of 9% at 12 months in 2013. 19 The stroke rate in our cohort significantly exceeded the highest observed rates in multiple historical cohorts of medically managed mild to moderate heart failure and in a recent analysis of patients with dramatically reduced ejection fraction (<15%), 20–23 which supports the conclusion that the association is with the VAD implant itself, not just with the patient population requiring the implant.…”

Section: Discussionsupporting

confidence: 64%

Stroke Risk and Mortality in Patients With Ventricular Assist Devices

Parikh

Cool

Karas

et al. 2016

Stroke

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Background and Purpose Ventricular assist devices (VADs) have advanced the management of end-stage heart failure. However, these devices are associated with hemorrhagic and thrombotic complications, including stroke. We assessed the incidence, risk factors, and outcomes of ischemic and hemorrhagic stroke after VAD placement. Methods Using administrative claims data from acute care hospitals in California, Florida, and New York from 2005–2013, we identified patients who underwent VAD placement, defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 37.66. Ischemic and hemorrhagic strokes were identified by previously validated coding algorithms. We used survival statistics to determine incidence rates and Cox proportional hazard analyses to examine associations. Results Among 1,813 patients, we identified 201 ischemic strokes and 116 hemorrhagic strokes during 3.4 (±2.0) years of follow-up after implantation of a VAD. The incidence of stroke was 8.7% per year (95% confidence interval [CI], 7.7–9.7%). The annual incidence of ischemic stroke (5.5%; 95% CI, 4.8–6.4%) was nearly double that of hemorrhagic stroke (3.1%; 95% CI, 2.6–3.8%). Women faced a higher hazard of stroke than men (hazard ratio [HR], 1.6; 95% CI, 1.2–2.1), particularly hemorrhagic stroke (HR, 2.2; 95% CI, 1.4–3.4). Stroke was strongly associated with subsequent in-hospital mortality (HR, 6.1; 95% CI, 4.6–7.9). Conclusions The incidence of stroke after VAD implantation was 8.7% per year, and incident stroke was strongly associated with subsequent in-hospital mortality. Notably, ischemic stroke occurred at nearly twice the rate of hemorrhagic stroke. Women appeared to face a higher risk for hemorrhagic stroke than men.

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Section: Discussionsupporting

confidence: 64%

Stroke Risk and Mortality in Patients With Ventricular Assist Devices

Parikh

Cool

Karas

et al. 2016

Stroke

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“…6, 13 We did not find an association of age, frequency of GI bleeding, or LVAD support duration with refractoriness to octreotide therapy, which was assessed by freedom from an event during 6-months of octreotide therapy. Hemodynamic, echocardiographic, or endoscopic parameters may be helpful to more fully uncover the global effects of octreotide therapy.…”

Section: Discussionmentioning

confidence: 65%

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

Juricek

Imamura

Nguyen

et al. 2018

Journal of Cardiac Failure

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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.

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“…The reason for eventually reduced bleeding could also be the reduced shear stress due to reduced speed or the different flow distribution between pump flow and direct flow through the aortic valve. A greater GIB rate in rotary pump recipients than in pulsatile VAD recipients has indeed been reported by several groups [37][38][39][40]. However, up to now no clinical setting could differentiate between reduced pulsatility due to rotary pumps and the degradation of vWF.…”

Section: Gastrointestinal Bleeding and Coagulation Disturbancesmentioning

confidence: 89%