Octreotide for Prevention of Repeat Gastrointestinal Bleeding in Patients With Left Ventricular Assist Device: Analysis of a Single-Center Cohort

Abstract

Introduction: Left ventricular assist devices (LVADs) are options for circulatory support in patients with end-stage heart disease. A common complication is gastrointestinal bleeding (GIB), with reported rates of up to 40%. Octreotide is postulated to be an effective medical therapy for prevention of recurrent GIB in patients with vascular lesions (visible vessel, arteriovenous malformation). We report our data of GIB in LVAD patients and the results of octreotide for prevention of repeat GIB. Methods: We conducted a retrospective chart review of all adult patients at a tertiary referral center who had an LVAD placed from January 1, 2008 to September 10, 2013. GIB episode was defined as a drop in hemoglobin with evidence of blood in the stool or a drop in hemoglobin by 1 g. Exclusion criteria included: epistaxis, GIB episodes within 1 week of LVAD implantation, or if less than 4 weeks’ data post-LVAD implantation. Demographics, disease-specific characteristics, LVAD type, number of GIB episodes, endoscopic data, and use of octreotide were recorded. Univariate analyses were performed to detect significant variables. Results: A total of 257 patients had LVAD implantation within the study period, with 33 patients excluded. Of the 224 patients analyzed, 70 (31.3%) had GIB, with 17.1% located in the stomach, 17.1% small bowel, 11.4% colon, 7.1% multiple areas, and 45.7% not found. Of the 54.3% of patients with an etiology of GIB, 60.5% were from a vascular source. A total of 33 patients had more than 1 episode of GIB (Table 1). Of the 33 patients with rebleeding, 14 were started on octreotide twice daily (42.4%), dose range 50-200 mcg (Table 2). Prior to octreotide therapy, the mean frequency of GIB was every 12.6 weeks (range 3.8-30.1), and after therapy, 35.2 weeks (range 13.1-56.8; p=0.002).Table 1: Characteristics of Patients With LVAD Implantation Included During Study PeriodConclusion: GIB after LVAD placement and rebleeding was common. Almost half of the patients with GIB have more than 1 episode. Octreotide significantly decreased the bleeding frequency in those with recurrent bleeding.