Incidence and management of gastrointestinal bleeding with continuous flow assist devices

Autor: Priya Sharma, Geetha Bhat, Shivani Kumar, Pat Pappas, Colleen Gallagher, Ashim Aggarwal, Antone Tatooles, Rojina Pant
Rok vydání: 2011
Předmět:
Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
Gastrointestinal bleeding
Time Factors
medicine.medical_treatment
Population
Kaplan-Meier Estimate
Risk Assessment
Severity of Illness Index
Statistics
Nonparametric
Cohort Studies
Age Distribution
Postoperative Complications
Cause of Death
medicine
Confidence Intervals
Odds Ratio
Humans
Hospital Mortality
Sex Distribution
education
Aged
Retrospective Studies
Heart Failure
Postoperative Care
education.field_of_study
business.industry
Incidence (epidemiology)
Incidence
Retrospective cohort study
Odds ratio
Middle Aged
medicine.disease
Survival Analysis
Surgery
Treatment Outcome
Ventricular assist device
Multivariate Analysis
Female
Heart-Assist Devices
Cardiology and Cardiovascular Medicine
Packed red blood cells
business
Gastrointestinal Hemorrhage
Destination therapy
Follow-Up Studies
Zdroj: The Annals of thoracic surgery. 93(5)
ISSN: 1552-6259
Popis: 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.
Databáze: OpenAIRE
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