title: Incidence and management of gastrointestinal bleeding with continuous flow assist devices.
abstract: BACKGROUND
  Continuous flow left ventricular assist devices (CF-LVADs) have emerged as the standard of care for patients in advanced heart failure (HF) requiring long-term mechanical circulatory support. Gastrointestinal (GI) bleeding has been frequently reported within this population.
  
  
  METHODS
  A retrospective analysis of 101 patients implanted with the Heart Mate II from January 2005 to August 2011 was performed to identify incidence, etiology, and management of GI bleeding. Univariate and multivariate regression analysis was conducted to identify related risk factors.
  
  
  RESULTS
  A significant incidence of GI bleeding (22.8%) occurred in our predominantly destination therapy (DT) (93%) population. Fifty-seven percent of the patients with bleeding episodes bled from the upper GI (UGI) tract (with 54% bleeding from gastric erosions and 37% from ulcers/angiodysplasias), whereas 35% of patients bled from the lower GI (LGI) tract. Previous history of GI bleeding (odds ratio [OR], 22.7; 95% CI, 2.2-228.6; p=0.008), elevated international normalized ratio (INR) (OR, 3.9; CI, 1.2-12.9; p=0.02), and low platelet count (OR, -0.98; CI, 0.98 -0.99; p=0.001) were independent predictors of GI hemorrhage. Recurrent bleeding was more common in older patients (mean, 70 years; p=0.01). The majority of bleeders (60%) rebled from the same site. Management strategies included temporarily withholding anticoagulation, decreasing the speed of LVADs, and using octreotide. Octreotide did not impact the amount of packed red blood cells used, rebleeding rates, length of hospital stay, or all-cause mortality. Only 1 patient died as a direct consequence of GI bleeding.
  
  
  CONCLUSIONS
  Multiple factors account for GI bleeding in patients on CF-VADs. A previous history of bleeding increases risk significantly and warrants careful monitoring.
authors.affiliation: Center for Heart Transplant and Assist Devices, Department of Cardiothoracic Surgery, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA.
authors.forename: Ashim
authors.initials: A
authors.lastname: Aggarwal
authors.forename: Rojina
authors.initials: R
authors.lastname: Pant
authors.forename: Shivani
authors.initials: S
authors.lastname: Kumar
authors.forename: Priya
authors.initials: P
authors.lastname: Sharma
authors.forename: Colleen
authors.initials: C
authors.lastname: Gallagher
authors.forename: Antone J
authors.initials: AJ
authors.lastname: Tatooles
authors.forename: Pat S
authors.initials: PS
authors.lastname: Pappas
authors.forename: Geetha
authors.initials: G
authors.lastname: Bhat
mesh_terms: D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome