Serotonergic agents increase the incidence of gastrointestinal bleeds in patients with continuous-flow left ventricular assist devices

Schultz, Jordan L.; Bream-Rouwenhorst, Heather R.; Hobbs, Ryan A.; McDanel, Deanna; Goerbig-Campbell, Jennifer

doi:10.1016/j.healun.2015.12.025

Cited by 10 publications

(9 citation statements)

References 5 publications

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“…The use of selective serotonin reuptake inhibitors (SSRIs) have been shown to improve quality of life in patients awaiting heart transplantation, but their use has been associated within increased GIB complications . It was evaluated whether the use of SSRI or other serotonergic agents (SAs) were associated with an increased bleeding risk in patients with CF‐LVADs. In 64 patients who received 73 LVAD implantations, a multivariate logistic regression model (adjusted for age, sex, and use of gastrointestinal [GI] prophylactic agents) showed that the adjusted odds of developing a GI bleed while taking an SA was 3.72 (95% CI 1.16–11.89, p=0.03).…”

Section: Pathophysiologymentioning

confidence: 99%

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: Pathophysiologymentioning

confidence: 99%

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

et al. 2017

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“…Few studies have identified SA use as a risk factor for bleeding in patients receiving CF-LVAD support despite a growing body of literature revealing a considerable bleed risk associated with SAs in other patient populations. [21][22][23][24][25][26][27] A small cohort study of 64 CF-LVAD patients found an increased risk of experiencing a GIB for patients receiving SAs (RR, 2.35; 95% CI, 1.05-5.28; p = 0.04) 33 , and another of 248 CF-LVAD patients also found an increased risk of GIB with SA use (RR, 1.46; 95% CI, 1.04-2.06; p = 0.030). 35 In addition, preliminary analysis of a retrospective study of 95 patients with CF-LVADs revealed a trend toward increased rate of hospitalization due to bleeding in patients treated with SA therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Although these data are observational, there are several strengths of our study in comparison to previous studies examining SA use in patients with CF-LVADs. We were able to include a significantly larger cohort than previously studied [33][34][35] including an appreciable number of HeartMate 3™ devices, which are being more frequently utilized given a favorable safety profile. We included many characteristics in our analyses that have been shown…”

Section: Discussionmentioning

confidence: 99%

“…[29][30][31][32] The degree to which SAs increase bleed risk in the CF-LVAD population has been infrequently studied. Three cohort studies have found an increased risk of experiencing GIB for CF-LVAD patients receiving SAs, though these studies have included small sample sizes, 33,34 no HeartMate 3™ devices, 33,35 and lacked analysis of other significant bleeding events including ICH or epistaxis. 33,35 Due to the sparse literature available regarding the association between bleeding and SA use in CF-LVAD patients, we sought to evaluate the impact of SA use on bleeding (GIB, ICH, and epistaxis) in patients supported with CF-LVADs.…”

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confidence: 99%

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Association of bleeding with serotonergic antidepressants in patients receiving left ventricular assist device support

et al. 2021

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“…In cardiac surgery, to date, SRI use and risk of bleeding has mainly been investigated in coronary artery bypass grafting (CABG) patients, who did not show an elevated bleeding risk under SRI medication [ 12 ]. Evidence on bleeding risk and SRI intake in VAD patients is hitherto scarce and limited to reports on an increased risk of gastrointestinal bleeding (GIB) in left ventricular assist device (LVAD) patients under SRI [ 13 ] and serotonergic antidepressants [ 14 ], respectively.…”

Section: Introductionmentioning

confidence: 99%

The use of serotonin reuptake inhibitors increases the risk of bleeding in patients with assist devices

Auschra

Wilhelm

Husung

et al. 2022

BMC Cardiovasc Disord

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Background Bleedings are frequent and dreaded complications in heart failure patients with ventricular assist devices (VAD). Serotonin reuptake inhibitor (SRI) antidepressants are widely used to treat depression in these patients, though they are attributed an increased risk of bleeding due to their modification of hemostasis. Evidence on bleeding risk of VAD patients under SRI medication is scarce and limited. We therefore aimed to assess if SRI use is associated with an elevated bleeding risk in this particularly vulnerable population. Methods We analyzed the medical records of 92 VAD patients at the University Heart Center Zurich between September 2004 and April 2018 for the occurrence of bleedings and the concomitant use of an SRI. Bleeding was defined as any type of post-implantation bleeding requiring medical treatment. We performed univariate analyses and linear mixed-effects models, adjusting for baseline clinical characteristics as potential predictors to identify differences in bleeding rates in patients with vs. without SRI intake. Results The cohort comprised 60.9% of patients with a continuous-flow VAD and 39.1% with a pulsatile-flow VAD. A total of 77.2% of patients experienced at least one bleeding incident. Overall, 28.6% of bleedings occurred under SRI therapy. A generalized linear mixed model showed a predictive effect of SRI medication on bleeding rate, independent of VAD type (z = 2.091, p = 0.037). Conclusions Bleeding events in heart failure patients occur frequently after VAD implantation. Patients with SRI medication were at increased risk of bleeding. The indication and use of SRI, therefore, should be considered carefully.

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Serotonergic agents increase the incidence of gastrointestinal bleeds in patients with continuous-flow left ventricular assist devices

Cited by 10 publications

References 5 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

Association of bleeding with serotonergic antidepressants in patients receiving left ventricular assist device support

The use of serotonin reuptake inhibitors increases the risk of bleeding in patients with assist devices

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