Serotonergic Antidepressants and Hospitalization for Bleeding in Patients with LVAD

Abstract

Purpose Serotonergic antidepressants (SA) are commonly used for a variety of indications in patients supported with durable left ventricular assist devices (LVAD). Reduced serotonin reuptake with SAs leads to platelet dysfunction and is associated with an increased risk of bleeding across diverse populations. There is limited data on the bleeding risk with SAs in the LVAD population prone to hemorrhagic complications due to other mechanisms. Methods We performed a retrospective analysis of LVAD patients (pts) managed at our institution from January 2016 to August 2018. Pertinent demographics and clinical variables related to bleeding were collected at the time of discharge from LVAD implantation and on admission for a bleeding event. Pts were divided into those prescribed an SA at discharge from LVAD implantation or admitted for a bleeding event with documented SA use prior to admission (Group 1) and those without SA exposure after implant (Group 2). Primary and secondary endpoints included incidence of bleeding requiring hospitalization, time from implant to first hospitalization for a bleeding event, and incidence rate of hospitalizations for bleeding per patient years. Results A preliminary analysis of 20 randomly selected pts out of 95 total implants performed. Ten pts were prescribed an SA (Group 1) and 10 were not (Group 2). Baseline demographics and bleeding risk factors were similar between the (two) 2 groups. Trazodone and sertraline were the most commonly prescribed SAs (35% each) and multiple SA use was common (50%). Acid suppressive therapy was used in all pts at discharge. In Group 1, 50% of the pts were hospitalized for a bleeding event compared to 10% of pts in Group 2 (p=0.1). At 1 year, 60% of pts remained free from hospitalization for a bleeding event in Group 1 compared to 100% in Group 2 (p=0.16). The number of bleeds per patient-year in Group 1 vs. those in Group 2 was 0.79 vs 0.4, respectively (p=0.26). Gastrointestinal (6 vs. 3 events) and intracranial (2 vs. 0 events) bleeding was more common in Group 1. Conclusion A preliminary analysis of patients with an LVAD treated with SA therapy demonstrated a trend towards an increased rate of hospitalization due to bleeding and a shorter time to first hospitalization compared to those who were not treated with an SA. Our final analysis will expand to all 95 patients to determine the significance of these findings.