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Characteristics of Gastrointestinal Bleeding After Placement of Continuous-Flow Left Ventricular Assist Device: A Case Series

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Abstract

Background

Medical management of patients with continuous-flow left ventricular assist devices (LVADs) remains challenging for the gastroenterologist given their high risk of gastrointestinal bleeding (GIB) and need for continuous anticoagulation.

Aims

Our aim was to better characterize LVAD patients who presented with a GIB at our facility and delineate the prevalence, presentation, time to diagnosis, management, and therapeutic endoscopic interventions, including small bowel tools that may offer additional benefit.

Methods

We retrospectively reviewed adult patients (>18 years) who underwent LVAD implantation at our tertiary care facility between October 2011 and October 2013. Electronic medical records were reviewed for presenting symptoms, average days to initial and repeat GIB, hospital course, and techniques that led to diagnosis and hemostasis.

Results

Eighteen patients underwent LVAD implantation, of which 61 % presented with a GIB for a total of 20 presentations (1.8 per patient). Mean time to initial GIB was 154 days. Patients required an average of 1.8 endoscopic procedures per admission. Esophagogastroduodenoscopy (EGD) and push enteroscopy (PE) were more likely to lead to a diagnosis, and EGD was the most commonly used diagnostic tool at initial presentation. Sixty percent of patients who initially received EGD presented with a recurrent GIB and required PE, which was diagnostic and therapeutic for small bowel angiodysplasias in 80 % of cases.

Conclusion

We found a higher GIB rate compared with prior studies. Bleeding events were associated with multiple procedures and interventions. We recommend an algorithmic approach to LVAD patients who bleed. Our experience suggests that PE is warranted at initial presentation in order to achieve hemostasis, prevent recurrent GIB, and decrease subsequent readmission rates.

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Acknowledgments

We thank Dr. Alex Reyentovich and Dr. Leora Balsam for their expertise in providing cardiac care to our LVAD patients at NYU.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Gastroenterology, Langone Medical Center, New York University School of Medicine, 240 East 38th Street, 23rd Floor, New York, NY, 10016, USA

    Jay Desai, Shannon Chang, Mark Pochapin & Grigoriy E. Gurvits

  2. Department of Medicine, New York University School of Medicine, New York, NY, USA

    Joseph Marsano

  3. Population Council, New York, NY, USA

    Michelle Chau

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  1. Joseph Marsano
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  2. Jay Desai
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Correspondence to Grigoriy E. Gurvits.

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Marsano, J., Desai, J., Chang, S. et al. Characteristics of Gastrointestinal Bleeding After Placement of Continuous-Flow Left Ventricular Assist Device: A Case Series. Dig Dis Sci 60, 1859–1867 (2015). https://doi.org/10.1007/s10620-015-3538-7

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  • DOI: https://doi.org/10.1007/s10620-015-3538-7

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