Experience of the use of octreotide for refractory gastrointestinal bleeding in a patient with Jarvik2000® left ventricular assist device

Autor: Satsuki Fukushima, Yorihiko Matsumoto, Masanobu Yanase, Seiko Nakajima-Doi, Tomoyuki Fujita, Sachi Matsuda, Shigeki Miyata, Koichi Kokame, Norihide Fukushima, Junjiro Kobayashi, Takuya Watanabe, Keiichiro Iwasaki, Yasuhiro Shintani, Yuto Kumai, Osamu Seguchi, Hiroki Mochizuki, Kensuke Kuroda, Koichi Toda, Yuka Eura, Yuki Kimura
Rok vydání: 2019
Předmět:
Zdroj: Journal of Artificial Organs. 22:334-337
ISSN: 1619-0904
1434-7229
DOI: 10.1007/s10047-019-01121-7
Popis: Gastrointestinal bleeding (GIB) is among the major complications affecting implantable continuous-flow left ventricular assist device (iLVAD) recipients and is the major cause of re-hospitalization. GIB in iLVAD recipients is sometimes critical, and controlling bleeding using conventional approaches is difficult. A 35-year-old woman developed refractory GIB from multiple gastric polyps and de novo angiodysplasia after Jarvik2000® iLVAD implantation. Discontinuation of anticoagulation and antiplatelet therapies had little effect on GIB; thus, multiple endoscopic hemostatic therapies were performed. However, bleeding recurred several times, and red blood cell (RBC) transfusion in large volumes was required for progressive anemia. Furthermore, the von Willebrand factor (VWF) multimer analysis revealed loss of the high-molecular weight multimer, which may have resulted from the high-speed rotation of the axial-flow LVAD pump. To supplement VWF, cryoprecipitate was administered, but it was effective for only several days. Finally, the patient was treated with octreotide, a somatostatin analog, on post-operative day 58. After starting octreotide, tarry stool gradually decreased, and progression of anemia slowed down within the first 14 days of treatment; thus, the total RBC transfusion volume was reduced without additional hemostatic interventions, including cryoprecipitate administration. The patient developed mediastinitis on post-operative day 68 and died of sepsis on post-operative day 72. There was no adverse effect associated with octreotide use. Although the observation period was short, octreotide appears to be useful for resolving recurrent GIB after iLVAD implantation and reducing blood transfusions.
Databáze: OpenAIRE
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