title: Gastrointestinal bleeding in patients with ventricular assist devices is highest immediately after implantation.
abstract: Ventricular assist device implantation is associated with gastrointestinal bleeding (GIB); however, outcomes in terms of initial and repeat GIB risk, severity, location of lesions, and endoscopic interventions need to be better defined. Consecutive patients from a database of adult patients with ventricular assist devices (VADs) implanted between January 1, 2000, and December 31, 2010, at a single center were reviewed and followed through May 31, 2011, in a retrospective manner. The GIB events were further classified by severity, lesion location, and lesion type. Hazard analysis models were calculated for the time to GIB events. Of 166 patients with a VAD, 38 patients experienced 84 GIB events. Seventeen patients experienced ≥2 GIB events. Maximal hazard for the first bleeding event was 2.23 events/patient-year at 21 days and declined to the constant hazard by 71 days postimplantation. The hazard for recurrent GIB was greatest immediately after the first GIB event. When considering all GIB events, most lesions (68%) were located in the proximal bowel. Angiodysplasia was the most common lesion type (17.5%) seen on endoscopy when all GIB events were considered, whereas ulcers were the most common type (13.8%) seen in initial GIB events. The actuarial risk of initial GIB events peaks in the first 3 months after VAD implantation followed by a stable lower risk of bleeding. The hazard for recurrent GIB events is substantially increased immediately after the initial GIB.
authors.affiliation: Graduate Medical Education, Department of Medicine, The University of Alabama of Birmingham, Internal Medicine Residency Training Program, BDB 327, 1720 2nd Ave South, Birmingham, AL 35294-0012, USA. jbfrench@uab.edu
authors.forename: Joshua B
authors.initials: JB
authors.lastname: French
authors.forename: Salpy V
authors.initials: SV
authors.lastname: Pamboukian
authors.forename: James F
authors.initials: JF
authors.lastname: George
authors.forename: George B
authors.initials: GB
authors.lastname: Smallfield
authors.forename: Jose A
authors.initials: JA
authors.lastname: Tallaj
authors.forename: Robert N
authors.initials: RN
authors.lastname: Brown
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Smallfield
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
authors.forename: William L
authors.initials: WL
authors.lastname: Holman
authors.forename: Shajan
authors.initials: S
authors.lastname: Peter
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D004724:Endoscopy / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000209:etiology*; D006333:Heart Failure / Q000150:complications / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants