Significantly higher rates of gastrointestinal bleeding and thromboembolic events with left ventricular assist devices.
OBJECTIVE
The risk of gastrointestinal (GI) bleeding (GIB) and thromboembolic events may increase with continuous-flow left ventricular assist devices (CF-LVADs). We aimed to characterize GIB and thromboembolic events that occurred in patients with CF-LVADs and compare them with patients receiving anticoagulation therapy.


METHODS
We performed a retrospective analysis of 159 patients who underwent CF-LVAD placement at 2 large academic medical centers (mean age, 55 ± 13 y). We identified and characterized episodes of GIB and thromboembolic events through chart review; data were collected from a time period of 292 ± 281 days. We compared the rates of GIB and thromboembolic events between patients who underwent CF-LVAD placement and a control group of 159 patients (mean age, 64 ± 15 y) who received a cardiac valve replacement and were discharged with anticoagulation therapy.


RESULTS
Bleeding events occurred in 29 patients on CF-LVAD support (18%; 45 events total). Sixteen rebleeding events were identified among 10 patients (range, 1-3 rebleeding episodes/patient). There were 34 thrombotic events among 27 patients (17%). The most common source of bleeding was GI angiodysplastic lesions (n = 20; 44%). GIB and thromboembolic events were more common in patients on CF-LVAD support than controls; these included initial GIB (18% vs 4%, P < .001), rebleeding (6% vs none, P = .001), and thromboembolic events (17% vs 8%, P = .01).


CONCLUSIONS
Patients with CF-LVADS receiving anticoagulants have a significantly higher risk of GIB and thromboembolic events than patients receiving anticoagulants after cardiac valve replacement surgery. GI angiodysplastic lesions are the most common source of bleeding.
Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia.
Charles W
CW
Shrode
Department of Medicine, Stanford University, Stanford, California.
Karen V
KV
Draper
Department of Medicine, Stanford University, Stanford, California.
Robert J
RJ
Huang
Division of Cardiology, University of Virginia, Charlottesville, Virginia.
Jamie L W
JL
Kennedy
Department of Medicine, University of Virginia, Charlottesville, Virginia.
Adam C
AC
Godsey
Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia.
Christine C
CC
Morrison
Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia.
Vanessa M
VM
Shami
Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia.
Andrew Y
AY
Wang
Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia.
John A
JA
Kern
Division of Cardiology, University of Virginia, Charlottesville, Virginia.
James D
JD
Bergin
Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia.
Gorav
G
Ailawadi
Division of Cardiology, Stanford University, Stanford, California.
Dipanjan
D
Banerjee
Division of Gastroenterology and Hepatology, Stanford University, Stanford, California. Electronic address: lgersonmd@yahoo.com.
Lauren B
LB
Gerson
Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia. Electronic address: bryansauer@virginia.edu.
Bryan G
BG
Sauer
D000328:Adult; D000368:Aged; D000818:Animals; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051381:Rats; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology*
Complication; Heart Failure; Hemorrhage; Morbidity; Treatment