Management options to treat gastrointestinal bleeding in patients supported on rotary left ventricular assist devices: a single-center experience
| Autor: | Helen M, Hayes, Lawrence G, Dembo, Robert, Larbalestier, Gerry, O'Driscoll |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Male
Time Factors Epinephrine Anticoagulants Proton Pump Inhibitors Western Australia Middle Aged Octreotide Prosthesis Design Adrenergic Agonists Endoscopy Gastrointestinal Treatment Outcome Gastrointestinal Agents Recurrence Humans Blood Transfusion Heart-Assist Devices Gastrointestinal Hemorrhage Platelet Aggregation Inhibitors Aged Retrospective Studies |
| Zdroj: | Artificial organs. 34(9) |
| ISSN: | 1525-1594 |
| Popis: | Gastrointestinal (GI) bleeding in ventricular assist devices (VADs) has been reported with rotary devices. The pathophysiological mechanisms and treatments are in evolution. We performed a retrospective review of GI bleeding episodes for all VADs implanted at our institution. Five male patients experienced GI bleeding-age 63.6 ± 3.64 years. VAD type VentrAssist n = 1, Jarvik 2000 n = 2, and HeartWare n = 2. All patients were anticoagulated as per protocol with antiplatelet agents (aspirin and/or clopidogrel bisulfate [Plavix] and warfarin (therapeutic international normalized ratio 2.0-3.5). There was no prior history of gastric bleeding in this group. Ten episodes of bleeding requiring blood transfusion occurred in five patients. Some patients had multiple episodes (1 × 5, 1 × 2, 3 × 1). The events occurred at varying times post-VAD implantation (days 14, 21, 26, 107, 152, 189, 476, 582, 669, and 839). Octreotide (a long-acting somatostatin analogue that reduces splanchnic arterial and portal blood flow) was administered subcutaneously or intravenously. Three patients received infusions of adrenaline at 1 µg/min to enhance pulsatility. Anticoagulation was interrupted during bleeding episodes but successfully introduced post bleeding event. GI bleeding is a significant complication of VAD therapy. In this article, we discuss diagnosis and management options. |
| Databáze: | OpenAIRE |
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