Treatment of left ventricular assist device-associated arteriovenous malformations with thalidomide.
Gastrointestinal bleeding because of arteriovenous malformations (AVMs) is an increasingly recognized complication of continuous flow left ventricular assist devices (LVADs). Currently, therapeutic options for LVAD-associated AVMs are limited and often require repeated endoscopic procedures and reduction or cessation of anticoagulation. Thalidomide has been utilized in the treatment of refractory bleeding because of gastrointestinal vascular malformations. Here we describe the case of a 66-year-old man with severe ischemic cardiomyopathy implanted with a continuous flow HeartMate II. His postoperative course was complicated by multiple hospital admissions for gastrointestinal bleeding because of LVAD-associated AVMs refractory to repeated argon plasma laser coagulation. Anticoagulation was discontinued with subsequent pump stoppage because of thrombus requiring urgent surgical pump exchange. Following this, thalidomide was initiated and anticoagulation with warfarin was continued. Since initiation of thalidomide, the patient has not had further gastrointestinal bleeding or evidence of pump thrombus in the subsequent 1 year.
From the *Department of Cardiovascular Medicine, Stanford University, Stanford, California; †Stanford Cardiovascular Institute, Stanford University, Stanford, California; ‡Heart Transplant Department, Northern California Kaiser Permanente, Oakland, California; and §Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
Ranjan
R
Ray
Parag P
PP
Kale
Richard
R
Ha
Dipanjan
D
Banerjee
D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D001165:Arteriovenous Malformations / Q000188:drug therapy* / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery; D013792:Thalidomide / Q000627:therapeutic use*; D014859:Warfarin / Q000627:therapeutic use
D020533:Angiogenesis Inhibitors; D000925:Anticoagulants; D013792:Thalidomide; D014859:Warfarin