Association between Digoxin Use and Gastrointestinal Bleeding in Contemporary Continuous Flow Left Ventricular Assist Device Support

Abstract

Digoxin use has been associated with reduced rate of gastrointestinal bleeding (GIB) in a previous study of patients on left ventricular assistive device (LVAD) support. The purpose of this study was to test the association between digoxin use and GIB events in a large, multicenter, contemporary dataset inclusive of HeartMate 3 devices. Patients with complete data on GIB events and digoxin use from two medical centers were included in the analysis (total n=650). GI bleeding events were captured out to 2 years of follow up and digoxin use was defined as digoxin prescribed at discharge or within the first 3 months after LVAD implantation. A negative binomial regression model was performed to determine association between digoxin use and number of GI bleeding events over 2 years of LVAD support. Mean age of the study cohort was 57 years (±14), 45 % were bridge to transplant (BTT), and 78% had HeartMate 2 devices. Thirteen % received HeartMate 3 devices. Digoxin was prescribed in 31% of patients. Patients on digoxin had better renal function at the time of LVAD implantation (1.19 vs 1.21, P= 0.037), lower INTERMACS profile (INTERMACS 2-3: 56 % vs. 48 %, P<0.001) and were less likely to be designated BTT (33% vs 51%, P < 0.001). Digoxin use was associated with a reduction in the incidence rate of GI bleeding on LVAD support (unadjusted 35% reduction in incidence rate ratio (IRR), 95% CI 3-56 % reduction, p =0.034, adjusted 36% reduction in IRR, 95% CI 3-58 % reduction, p =0.038). The final model was adjusted for age, INTERMACS profile, BTT status, creatinine, right atrial pressure and ace-inhibitor or angiotensin receptor blocker use. In this large multicenter study, inclusive of the most contemporary devices, digoxin use was associated with reduced GI bleeding events. Prospective data will be required to confirm this hypothesis.