(653) - Danazol as a Treatment to Reduce Reoccurrence of Hospitalization for Gastrointestinal Bleeding in Patient with Continuous Flow Left Ventricular Assist Device

Abstract

Gastrointestinal bleeding is one of the most common adverse events and causes and re-hospitalization in patient with LVAD. Medical management of these patients continues to be challenging given the need for continuous anticoagulation. In some case reports, Danazol, a weak androgen, was suggested for prevention of recurrent GIB. The purpose of this study was to determine the reoccurrence of gastrointestinal bleeding (GIB) after implantation of Left Ventricular Assist Device (LVAD) before and after the treatment with Danazol. Data were collected by retrospective analysis of adult patients (>18 years) who underwent continuous flow LVAD implantation at University of Kentucky Hospital between 2012 and 2015. Electronic medical records were reviewed for presenting symptoms, average days to initial and repeat GI bleed and treatment of GI bleed. In the studied period of time, 93 patients received a continuous flow LVAD. Six patients with LVAD implantation who presented with Gastrointestinal bleeding (GIB) were placed on Danazol. One patient discontinued the drug because of side effects. In the remaining five patients, mean time to initial GIB after LVAD implant was 9.6 months. Only one patient was started on Danazol after the first episode of GIB, while the rest of them had recurrent events. The average number of episodes of GIB was 3.4. Before Danazol, mean time in between hospital readmissions related to recurrent GIB was 1.5 months. After the patients were initiated on Danazol for treatment of GIB, mean time in between hospital readmissions related to recurrent GIB after initiation of Danazol increased to 4.4 months. Only one patient experienced another episode of GIB on Danazol. The four that did not remained free of GIB for an average of 2.9 months. After that, two were transplanted and the other two continue to be on LVAD support. Danazol may increase the intervals between the episodes of GIB and prevent the recurrent episode in some patient with LVADS. Danazol should be considered as a treatment in patients with LVAD and GIB.