Gerrald JE, Ather A, Schadler A, Birks EJ, Kolodziej AR, Kuan W. Retrospective Review of Secondary Prevention Strategies for Gastrointestinal Bleeding and Associated Clinical Outcomes in Left Ventricular Assist Device Patients.
Artif Organs 2022;
46:2423-2431. [PMID:
35578786 DOI:
10.1111/aor.14316]
[Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND
Gastrointestinal bleeding (GIB) is one of the most common bleeding complications associated with Left Ventricular Assist Devices (LVAD). Currently, there is no strong evidence or clear guidance for which secondary GIB prophylaxis strategy should be implemented after the discontinuation of aspirin.
METHODS
Our single-center study describes the outcomes of 26 LVAD patients who experienced a total of 49 GIB events, these individuals were either in Group-1) lower INR target range or Group-2) lower INR target plus a hemostatic agent as the secondary prophylaxis strategy. Each GIB event was considered an independent event. Outcomes assessed were bleeding reoccurrence rates, time to next GIB, acute GIB strategies, GIB-free days, thromboembolic events, survival, coagulation, and hematologic parameters.
RESULTS
GIB reoccurrence rates were not statistically different, Group-1) 9 (40.9%) vs Group-2) 15 (55.6%), p = 0.308. Danazol was utilized 81.5% of the time as the designated hemostatic agent. Additionally, no significant differences were observed with all of our secondary outcome measures for bleeding, ischemic events, or survival.
CONCLUSION
While our study was not powered to assess the clinical outcomes related to survival and thromboembolic events, no discernable increased risk of ischemic events including pump thrombosis was observed. Our data suggest that a lower INR target range plus danazol does not confer any additional benefit over a lower INR target range only approach. The results of this report are hypothesis-generating and additional studies are warranted to elucidate the optimal antithrombotic strategy and role of hemostatic agents in reducing the risk of recurrent GIB events.
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