Systemic Octreotide Therapy in Prevention of Gastrointestinal Bleeds Related to Arteriovenous Malformations and Obscure Etiology in Atrial Fibrillation
| Autor: | Valay Parikh, Madhav Lavu, Venkat Vuddanda, Mohit K. Turagam, Mojtaba Olyaee, Donita Atkins, Vijay Swarup, Luigi Di Biase, Mohammad-Ali Jazayeri, Dhanunjaya Lakkireddy, Madhu Reddy Yeruva, Rakesh Gopinathannair, Andrea Natale, Sudharani Bommana, Jie Cheng, Vijay Ivaturi |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Injections Subcutaneous medicine.medical_treatment Octreotide 030204 cardiovascular system & hematology Risk Assessment Arteriovenous Malformations 03 medical and health sciences 0302 clinical medicine Gastrointestinal Agents Atrial Fibrillation medicine Humans Atrial Appendage Stroke Colectomy Aged business.industry Incidence (epidemiology) Atrial fibrillation Middle Aged Bleed medicine.disease Surgery Discontinuation Etiology Female 030211 gastroenterology & hepatology Gastrointestinal Hemorrhage business Follow-Up Studies medicine.drug |
| Zdroj: | JACC: Clinical Electrophysiology. 3:1390-1399 |
| ISSN: | 2405-500X |
| Popis: | Objectives The present study describes the use of octreotide (OCT) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC) who have gastrointestinal (GI) bleeding related to arteriovenous malformations (AVMs), as well as its effect on OAC tolerance and subsequent rebleeding. Background AVMs cause significant GI bleeding, especially in patients with AF who are receiving OAC for stroke prevention. OCT has been shown to minimize recurrent GI bleeds related to AVMs. Methods In a multicenter, observational study, 38 AF patients with contraindications to OAC because of AVM-related GI bleeding were started on 100 μg of subcutaneous OCT twice daily. OAC was resumed in all patients within 48 h. Incidence of recurrent GI bleeds was calculated, and hemoglobin levels were recorded at enrollment and at 3 and 6 months’ follow-up. Results After a median follow-up of 8 months, 36 patients (mean age 69 ± 8.0 years; mean CHA2DS2-VASc score 3 ± 1 and mean HAS-BLED score 3 ± 1) were available for analysis. All were able to successfully resume OAC, and 28 of 36 (78%) remained on OAC at the conclusion of the study, whereas 8 underwent left atrial appendage closure with subsequent OAC discontinuation. No systemic thromboembolic events occurred in follow-up. Of the 28 patients who continued receiving OAC, 19 (68%) were free of recurrent GI bleed, 4 had minor GI bleeds, 4 required transfusion, and 1 required colectomy for GI bleeding. Mean hemoglobin levels in all patients receiving OAC were significantly higher at 3- and 6-month follow-up than at baseline (p Conclusions Subcutaneous OCT therapy is an attractive option in AF patients receiving OAC who have AVM-related GI bleeds. It allows successful reinitiation of OAC as a bridge to left atrial appendage exclusion or short-term relief from bleeding. |
| Databáze: | OpenAIRE |
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