Abstract 17337: The Effect of Digoxin on Hemocompatibility Related Adverse Events in Patients With Durable Left Ventricular Assist Devices

Abstract

Introduction: Hemocompatibility-related adverse events (HRAE) including stroke, pump thrombosis, and gastrointestinal bleeding (GIB), is a major cause of mortality in patients with continuous flow left ventricular assist devices (CF-LVAD). Digoxin (dig) is used in treatment of advanced heart failure, and has been implicated in decreasing angiogenesis via HIF-alpha/TGF inhibition. There is conflicting data regarding the effect of dig on GIB rates in patients with cf-LVADs. We investigated the association of dig use in patients implanted with CF-LVADs with HRAE with both centrifugal and axial flow devices. Methods: 12,002 patients from the INTERMACS registry implanted with cf-LVADs between 2012-2017 and were alive at 1-month were included. The event rates of HRAE at 1-yr post implant were compared in patients with or without dig use at 1-month post implant. Cox proportional hazards modeling was used to assess the independent association of dig use and HRAE. Results: There was no significant difference in age, sex, race, Cr, INR, DM, and AST in those who were prescribed vs. not prescribed dig at 1 month. On univariate analysis, dig was associated with decreased HRAE in patients with CF-LVADs at 1-year post implantation (37% vs 41%, p<0.01) (Fig. 1) however this was primarily driven by decreased neurologic events. There was no association with GIB (p 0.18). On multivariate analysis, dig was not found to be an independent predictor of HRAE (HR 0.95, 95% CI 0.89-1.02, p 0.2) (Figure 2). Conclusions: Despite previous smaller studies which suggested a decreased risk of HRAE and GIB in patients with cf-LVADs, we found that dig was not an independent predictor of HRAE.