Atrial Fibrillation is Associated with Increased Incidence of Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device: Systematic Review and Meta-Analysis

Abstract

Background Gastrointestinal bleeding (GIB) can be a devastating complication after left ventricular assist device (LVAD) implantation. Atrial fibrillation (AF) is a common arrhythmia in LVAD patients. Little is known about the association between AF and GIB in LVAD population. Method We performed a comprehensive literature search through March 2019 using MEDLINE, EMBASE, Scopus and the Cochrane Library. Included studies were prospective or retrospective cohort studies that compared the risk of developing GIB in LVAD patients with and without AF. We calculated pooled odds ratio (OR) with 95% confidence intervals (CI) and I2 statistic using the random-effects model. Results Five studies were considered for the analysis including 1,258 LVAD patients; 512 with AF (40.7%) and 746 without AF (59.3%). After a median follow-up period of 9 months to 2 years, 349 (27.7%) patients developed GIB; 167 (32.6%) patients in AF group and 182 (24.4%) patients in non-AF group. There was a significant association between AF and increased incidence of GIB during LVAD support (OR = 1.50; 95%CI = 1.16-1.93, p = 0.002) (I2 =0%). Conclusion Our meta-analysis suggests that nearly half of LVAD population have concomitant AF. Presence of AF is associated with an increased risk of GIB during LVAD support. This should be taken into consideration when choosing anticoagulation strategy for LVAD patients with AF.