| Incidence and management of gastrointestinal bleeding with continuous flow assist devices. | |
| | |
MedLine Citation:
|
PMID: 22541185 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
|
BACKGROUND: Continuous flow left ventricular assist devices (CF-LVADs) have emerged as the standard of care for patients in advanced heart failure (HF) requiring long-term mechanical circulatory support. Gastrointestinal (GI) bleeding has been frequently reported within this population. METHODS: A retrospective analysis of 101 patients implanted with the Heart Mate II from January 2005 to August 2011 was performed to identify incidence, etiology, and management of GI bleeding. Univariate and multivariate regression analysis was conducted to identify related risk factors. RESULTS: A significant incidence of GI bleeding (22.8%) occurred in our predominantly destination therapy (DT) (93%) population. Fifty-seven percent of the patients with bleeding episodes bled from the upper GI (UGI) tract (with 54% bleeding from gastric erosions and 37% from ulcers/angiodysplasias), whereas 35% of patients bled from the lower GI (LGI) tract. Previous history of GI bleeding (odds ratio [OR], 22.7; 95% CI, 2.2-228.6; p = 0.008), elevated international normalized ratio (INR) (OR, 3.9; CI, 1.2-12.9; p = 0.02), and low platelet count (OR, -0.98; CI, 0.98 -0.99; p = 0.001) were independent predictors of GI hemorrhage. Recurrent bleeding was more common in older patients (mean, 70 years; p = 0.01). The majority of bleeders (60%) rebled from the same site. Management strategies included temporarily withholding anticoagulation, decreasing the speed of LVADs, and using octreotide. Octreotide did not impact the amount of packed red blood cells used, rebleeding rates, length of hospital stay, or all-cause mortality. Only 1 patient died as a direct consequence of GI bleeding. CONCLUSIONS: Multiple factors account for GI bleeding in patients on CF-VADs. A previous history of bleeding increases risk significantly and warrants careful monitoring. |
| | |
Authors:
|
Ashim Aggarwal; Rojina Pant; Shivani Kumar; Priya Sharma; Colleen Gallagher; Antone J Tatooles; Pat S Pappas; Geetha Bhat |
Related Documents
:
|
22205695 - Growth-differentiation factor-15 in the early diagnosis and risk stratification of pati... 21949105 - Pallidal deep brain stimulation for dyt6 dystonia. 22554905 - Acute limbic encephalitis with focal hyperperfusion on single photon emission computed ... 22075285 - The use of terlipressin in cirrhotic patients with refractory ascites and normal renal ... 8544635 - The swallowing side effects of botulinum toxin type a injection in spasmodic dysphonia. 3543385 - Chloroquine-resistant falciparum malaria from east africa. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The Annals of thoracic surgery Volume: 93 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2012 May |
Date Detail:
|
Created Date: 2012-04-30 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
|
Languages: eng Pagination: 1534-40 Citation Subset: AIM; IM |
Copyright Information:
|
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
|
Center for Heart Transplant and Assist Devices, Oak Lawn, Illinois. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Sutureless perceval aortic valve replacement: results of two European centers.
Next Document: Neurodevelopmental outcomes after open heart operations before 3 months of age.