title: GI bleeding in patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis.
abstract: BACKGROUND
  Patients with left ventricular assist devices (LVADs) are at increased risk of GI bleeding (GIB), primarily from GI angiodysplastic lesions (GIAD).
  
  
  OBJECTIVE
  To perform meta-analysis of the medical literature in order to determine prevalence and risk factors for GIB.
  
  
  METHODS
  A literature search was performed to identify studies reporting GIB in LVAD patients. We extracted rates of prevalence, rebleeding, and overall mortality from each study. Pooled event rates and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
  
  
  METHODS
  Meta-analysis of 17 case-control and cohort studies.
  
  
  METHODS
  A total of 1839 LVAD patients of whom 1697 (92%) had continuous-flow LVADs.
  
  
  RESULTS
  The pooled prevalence of GIB in LVAD patients was 23% (95% CI, 20.5%-27%). Subgroup analysis demonstrated that older age (standard difference in means (SDm), 0.69; 95% CI, 0.23-1.15), and elevated creatinine (SDm, 0.65; 95% CI, 0.12-1.18, P = .02) were associated with GIB. Risk factors not associated with GIB included LVAD as destination therapy (OR 1.85; 95% CI, 0.8-4.3), prior history of GIB (OR 2.22; 95% CI, 0.83-5.96), hypertension (OR 1.6; 95% CI, 0.87-2.97), and/or the presence of a continuous-flow LVAD (OR 4.5; 95% CI, 2.1-9.5). Recurrence of GIB occurred in 9.3% (95% CI, 7%-12%), with a GIB mortality rate of 23% (95% CI, 16%-32%). The pooled event rates were 48% (95% CI, 39%-57%) for upper GIB, 22% (95% CI, 16%-31%) for lower GIB, and 15% (95% CI, 8%-25%) for small-bowel bleeding. GIAD in the proximal GI tract were the most common cause of GIB (29%).
  
  
  CONCLUSIONS
  Lack of information regarding endoscopic therapy and follow-up in most studies.
  
  
  CONCLUSIONS
  The prevalence of GIB is increased in patients with continuous-flow LVADs, primarily secondary to the presence of GIAD.
authors: Division of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors: Karen V
authors: KV
authors: Draper
authors: Division of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors: Robert J
authors: RJ
authors: Huang
authors: Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA.
authors: Lauren B
authors: LB
authors: Gerson
mesh_terms: D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D016017:Odds Ratio; D012307:Risk Factors