title: Left ventricular assist devices and gastrointestinal bleeding: a narrative review of case reports and case series.
abstract: BACKGROUND
  The use of left ventricular assist devices (LVADs) has become a state-of-the-art therapy for advanced cardiac heart failure; however, multiple reports in the literature describe an increased risk for gastrointestinal (GI) bleeding in these patients. We characterized this association by reviewing recent studies on this topic.
  
  
  OBJECTIVE
  GI bleeding occurs frequently in patients with LVADs, especially with devices with nonpulsatile flow patterns.
  
  
  METHODS
  We performed a comprehensive literature review to identify articles that reported GI bleeding in patients with LVADs. Databases used included PubMed, EMBASE, Scopus, Web of Knowledge, and Ovid. Baseline and outcome data were then ed from these reports.
  
  
  RESULTS
  We identified 10 case reports and 22 case series with 1543 patients. The mean age was 54.2 years. Most patients had nonpulsatile LVADs (1316, 85.3%). Three hundred and seventeen patients (20.5%) developed GI bleeding; this occurred more frequently in patients with nonpulsatile LVADs. Multiple procedures were performed without complications but often did not identify a definite bleeding site. Suspect lesions occurred throughout the GI tract but were more frequent in the upper GI tract. Many patients had arteriovenous malformations. All patients received medical therapy. None of the patients had their LVAD replaced. The use of anticoagulation did not appear to predispose these patients to more GI bleeding episodes.
  
  
  CONCLUSIONS
  Patients with LVADs have frequent GI bleeds, especially from arteriovenous malformations, which can occur throughout the GI tract. Most diagnostic and therapeutic interventions can be used safely in these patients. The pathogenesis of the GI bleeding in these patients may involve the use of anticoagulant medications, the formation of arteriovenous malformations, loss of von Willebrand factor activity, and mucosal ischemia.
authors: Department of Gastroenterology, Mayo Clinic, Scottsdale, Arizona 85259, USA. islam.rafiul@mayo.edu
authors: Sameer
authors: S
authors: Islam
authors: Cihan
authors: C
authors: Cevik
authors: Rosalinda
authors: R
authors: Madonna
authors: Wesam
authors: W
authors: Frandah
authors: Ebtesam
authors: E
authors: Islam
authors: Sherazad
authors: S
authors: Islam
authors: Kenneth
authors: K
authors: Nugent
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001165:Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006333:Heart Failure / Q000150:complications / Q000628:therapy; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D011673:Pulsatile Flow; D012008:Recurrence; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy
chemical_list: D000925:Anticoagulants
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