Significantly Higher Rates of Gastrointestinal Bleeding and Thromboembolic Events With Left Ventricular Assist Devices CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Shrode, C. W., Draper, K. V., Huang, R. J., Kennedy, J. L., Godsey, A. C., Morrison, C. C., Shami, V. M., Wang, A. Y., Kern, J. A., Bergin, J. D., Ailawadi, G., Banerjee, D., Gerson, L. B., Sauer, B. G. 2014; 12 (9): 1461-1467

Abstract

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.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.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).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.

View details for DOI 10.1016/j.cgh.2014.01.027

View details for Web of Science ID 000341127900013

View details for PubMedID 24480675