Gastrointestinal angiodysplasia is associated with significant gastrointestinal bleeding in patients with continuous left ventricular assist devices

Justin Cochrane; Christian Jackson; Greg Schlepp; Richard Strong

doi:10.1055/s-0042-101752

Endoscopy International Open, Inhaltsverzeichnis

Endosc Int Open 2016; 04(03): E371-E377
DOI: 10.1055/s-0042-101752

Original article

Gastrointestinal angiodysplasia is associated with significant gastrointestinal bleeding in patients with continuous left ventricular assist devices

Justin Cochrane

¹Assistant Clinical Associate Professor University of Washington Medical School, Providence Sacred Heart Medical Center Internal Medicine Residency Spokane, Washington, United States

,

Christian Jackson

²Loma Linda University Medical Center, Department of Medicine, Section of Gastroenterology, Loma Linda, California, United States

,

Greg Schlepp

³Spokane Digestive Disease Center Spokane, Washington, United States

,

Richard Strong

²Loma Linda University Medical Center, Department of Medicine, Section of Gastroenterology, Loma Linda, California, United States

› Institutsangaben

Abstract

Background and study aims: Patients with a continuous-flow left ventricular assist device (LVAD) have a 65 % incidence of bleeding events within the first year. The majority of gastrointestinal bleeding (GIB) is from gastrointestinal angiodyplasia (GIAD). The primary aim of the study was to determine whether GIAD was associated with a higher rate of significant bleeding, an increased number of bleeding events per year, and a higher rate of transfusion compared to non-GIAD sources.

Patients and methods: This retrospective cohort study included 118 individuals who received a LVAD at a tertiary medical center from 2006 through 2014. Patients were subdivided into GIB and non-GIB for comparison of patient demographics, comorbid conditions, and laboratory data. GIB was further divided into sources of GIB, GIAD, obscure, or non-GIAD to establish severity of bleeding, rate of re-bleeding, and transfusion rate.

Results: GIAD is associated with an increased number of bleeding events compared to non-GIAD sources of GIB (2.07 vs 1.23, P = 0.01) and a higher number of bleeding events per year (0.806 vs. 0.455 P = 0.001). GIAD compared to non-GIAD sources of GIB was associated with an increased incidence of major bleeding (100 % vs 60 %, P = 0.006) and increased rates of transfusion (8.8 vs 2.95 units, P = 0.0004). Cox Regression analysis between non-GIB and GIAD demonstrated increased risk with age (P = 0.001), history of chronic kidney disease (P = 0.005), and length of stay after LVAD implantation of more than 45 days (P = 0.04). History of hypertension (P = 0.045), diabetes mellitus (P = 0.016), and male gender was associated with decreased risk (P = 0.04).

Conclusion: Patients with a continuous-flow LVAD who develop a GIB secondary to GIAD have a higher rate of major bleeding, multiple bleeding events, and require more transfusions to achieve stabilization compared to patients who do not have GIAD.

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