title: Evaluation of GI bleeding after implantation of left ventricular assist device.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) have revolutionized the management of end-stage heart failure (ESHF). However, unexpectedly high rates of GI bleeding (GIB) have been described, and etiology and outcome remain unclear.
  
  
  OBJECTIVE
  To determine the prevalence, etiology, and outcome of GIB in LVAD recipients.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary care academic university hospital.
  
  
  METHODS
  154 ESHF patients (55.4 years, 122 men/32 women) with LVADs implanted over a 10-year period.
  
  
  METHODS
  Overt or occult GIB prompting endoscopic evaluation ≥ 7 days after LVAD implantation.
  
  
  RESULTS
  Over a mean of 0.9 ± 0.1 years of follow-up, 29 patients (19%) experienced 44 GIB episodes. Patients with GIB were older and received anticoagulation therapy before devices were implanted (P ≤ .02 for each). GIB was overt (n = 31) rather than occult (n = 13), and most patients presented with melena (n = 22, 50%); hemodynamic instability was observed in 13.6%. Each bleeding episode required 2.1 ± 0.1 diagnostic or therapeutic procedures, and a source was localized in 71%. Upper endoscopy provided the highest diagnostic yield; peptic bleeding (n = 14) and vascular malformations (n = 8) dominated the findings. Endoscopy was safe and well tolerated. Overall mortality was 35%, none directly from GIB.
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  Rates of GIB with LVADs are higher than that seen in other patient populations, including those receiving anticoagulation and antiplatelet therapy. GIB episodes are mostly overt and predominantly from the upper GI tract. Endoscopy is safe in the LVAD population.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, Saint Louis, Missouri, USA.
authors.forename: Vladimir M
authors.initials: VM
authors.lastname: Kushnir
authors.forename: Shivak
authors.initials: S
authors.lastname: Sharma
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.forename: Jonathan
authors.initials: J
authors.lastname: Seccombe
authors.forename: Eric
authors.initials: E
authors.lastname: Novak
authors.forename: I-Wen
authors.initials: IW
authors.lastname: Wang
authors.forename: Susan M
authors.initials: SM
authors.lastname: Joseph
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008551:Melena / Q000209:etiology; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000209:etiology; D016012:Poisson Distribution; D015995:Prevalence; D019919:Prosthesis Implantation; D012008:Recurrence; D012189:Retrospective Studies; D054079:Vascular Malformations / Q000150:complications / Q000175:diagnosis
chemical_list: D000925:Anticoagulants