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Features of Patients with Gastrointestinal Bleeding Following Implantation of Ventricular Assist Devices.
Clin Gastroenterol Hepatol. 2014 May 21;
Authors: Singh G, Albeldawi M, Kalra SS, Mehta PP, Lopez R, Vargo JJ
Abstract
BACKGROUND: & Aims: Ventricular assist devices (VADs) are used to treat patients with end-stage heart disease. However, patients with VADs frequently develop gastrointestinal (GI) bleeding. We investigated the incidence, etiology, and outcome of GI bleeding in patients with VADs.
METHODS: In a retrospective study, we analyzed data from 391 consecutive patients (mean age 53.9 ± 14.2 years old, 81% male) who underwent VAD implantation for end-stage heart disease from January 2000 through May 2012 at the Cleveland Clinic. Multivariable logistic regression analysis was used to identify factors independently associated with GI bleeding in patients with VADs.
RESULTS: Sixty-two patients (15.9%) had GI bleeding. The risk of GI bleeding increased by 10% for every 5 year increase in age (P=.006). GI bleeding was also associated with lower body mass index (P=.046), current smoking (P=.007), and lower baseline levels of hemoglobin (P<.001). Bleeding was primarily overt (79%), and most patients presented with hematochezia (43.5%). Causes of bleeding were primarily vascular malformations (26.5%) and ulcers (26.5%). Patients who received VADs as their only therapy, rather than as a bridge to transplantation, were more likely to have GI bleeding (P=.008). Colonoscopy detected GI bleeding with the highest diagnostic yield; most bleeding was associated with colonic lesions (51.4%). Overall mortality was 39.4%, and 2 deaths were directly related to GI bleeding.
CONCLUSION: Based on a large case series analysis, GI bleeding is common following implantation of VADs (15.9% of patients have at least 1 episode of bleeding). Episodes were mostly overt and predominantly from the lower GI tract; colonoscopy is the best method of detection.
PMID: 24858705 [PubMed - as supplied by publisher]