title: Management options to treat gastrointestinal bleeding in patients supported on rotary left ventricular assist devices: a single-center experience.
abstract: Gastrointestinal (GI) bleeding in ventricular assist devices (VADs) has been reported with rotary devices. The pathophysiological mechanisms and treatments are in evolution. We performed a retrospective review of GI bleeding episodes for all VADs implanted at our institution. Five male patients experienced GI bleeding-age 63.6 ± 3.64 years. VAD type VentrAssist n = 1, Jarvik 2000 n = 2, and HeartWare n = 2. All patients were anticoagulated as per protocol with antiplatelet agents (aspirin and/or clopidogrel bisulfate [Plavix] and warfarin (therapeutic international normalized ratio 2.0-3.5). There was no prior history of gastric bleeding in this group. Ten episodes of bleeding requiring blood transfusion occurred in five patients. Some patients had multiple episodes (1 × 5, 1 × 2, 3 × 1). The events occurred at varying times post-VAD implantation (days 14, 21, 26, 107, 152, 189, 476, 582, 669, and 839). Octreotide (a long-acting somatostatin analogue that reduces splanchnic arterial and portal blood flow) was administered subcutaneously or intravenously. Three patients received infusions of adrenaline at 1 µg/min to enhance pulsatility. Anticoagulation was interrupted during bleeding episodes but successfully introduced post bleeding event. GI bleeding is a significant complication of VAD therapy. In this article, we discuss diagnosis and management options.
authors.affiliation: Royal Perth Hospital-AHFCTS, Perth, Western Australia, Australia. helen.hayes@health.wa.gov.au
authors.forename: Helen M
authors.initials: HM
authors.lastname: Hayes
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Dembo
authors.forename: Robert
authors.initials: R
authors.lastname: Larbalestier
authors.forename: Gerry
authors.initials: G
authors.lastname: O'Driscoll
mesh_terms: D000322:Adrenergic Agonists / Q000627:therapeutic use; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D001803:Blood Transfusion; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011474:Prosthesis Design; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014904:Western Australia
chemical_list: D000322:Adrenergic Agonists; D000925:Anticoagulants; D005765:Gastrointestinal Agents; D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D015282:Octreotide; D004837:Epinephrine