2895 Recurrent Bleeding in Patients With LVADs: Endoscopic Yield and Impact of Endoscopic Intervention

Abstract

INTRODUCTION: Patients with LVADs are at increased risk for gastrointestinal bleeds (GIBs) because of chronic anticoagulation and high flow states. A prior retrospective study at our institution confirmed that 22% of patients with LVADs had a GIB after implantation, consistent with prior literature. There are no evidence-based guidelines regarding the role of repeat endoscopic procedures for recurrent GIB, resulting in varying practice patterns among Cardiology and GI teams. It is unknown how often repeat inpatient endoscopic examinations during hospitalizations result in intervention or reduction in future GIB episodes. We sought to assess the proportion of endoscopic intervention and impact on recurrent GIB. METHODS: We conducted a retrospective cohort study of all patients at one academic institution who underwent LVAD implantation between March 2016 through February 2018. For each patient, we assessed post implant hospital encounters for GIBs through May 2019. The primary outcome was the odds ratio for a future GIB based on the occurrence of endoscopic intervention versus none (endoscopy with no intervention or no procedure). Secondary outcomes included endoscopic intervention based on overt versus occult GIB. RESULTS: The cohort included 105 patients who had LVADs implanted during the stated time. 34 patients (32%) presented for GIBs during the study period, with a total of 71 encounters. A third or higher encounter occurred in 26% of patients (9/34) and accounted for 27% (19/71) of encounters. 79% of all encounters (56/71) included at least one invasive endoscopic evaluation; an endoscopic intervention was performed in 41% (23/56). The odds ratio for future GIB after endoscopic intervention during the first GIB (34/71) was 0.2 (95% CI 0.04-0.97, P = 0.046) but was not statistically significant if the intervention was during a recurrent GIB (37/71) (0.33, 95% CI 0.08 - 1.41, P = 0.14). The odds ratio of performing an intervention during endoscopic procedure for overt versus occult GIB was 3.4 (95% CI 0.98-11.7231, P = 0.053), trending towards significant. CONCLUSION: Patients with LVADs who have recurrent GIBs experience repeat admissions and endoscopic procedures. In our cohort, endoscopic interventions for repeat GIB did not have an impact on future episodes of GIB. Our data suggest that the endoscopic yield is likely lower with occult GIB.There is a clinical need to identify characteristics of LVAD patients at risk and to develop guidelines for the management of patients with recurrent GIB.