Purpose: LVAD patients have a high incidence of GI bleeding (GIB). The etiology for GIB is poorly understood, and patient populations have been inadequately described. Treatment pathways for localizing GIB sites, and the subsequent management of the patients are currently unclear. Methods: All CFLVADS implanted between January 2008 and November 2013 were reviewed and patients demographics, presentation and treatment strategies were evaluated. Results: 321 continuous flow LVAD patients (male= 265, female= 56; 292 HM2, 29 HVAD) were evaluated. Median age was 61 yrs at time of implant (mean 57 +/-13 yrs). 82 LVAD patients had 138 hospitalization for confirmed GIB. Overall, 26% (82/321) of patients implanted had at least one GIB. Of these, 22% (18/82) experienced multiple GIB. There was no significant difference across gender with 28% of men (75/265) and 20% of women (11/56) experiencing GIB (p= 0.2446), or with device type 28% of HVAD (8/29) vs. 25% of HM II (74/292) (Half of all GIB events were seen within the first 47 days post LVAD implant. Lower INTERMACS score was not associated with earlier time to first GIB (p= 0.3404). At first GIB, Aortic Valve was confirmed to be opening in 58% of patients with 31% having a palpable pulse. At discharge for first GIB, 51% of patients were restarted on both aspirin and warfarin, 15% were started on aspirin only, and 12% were started on warfarin only. Choice of therapy was not significantly different among patients with recurrent GIB.
Conclusion:
There is a high rate of GIB in the LVAD patient population. Fortunately, the majority have a single event, which may be reassuring to patients. Most initial GIBs occur within the first 47 days post-implant. This may help focus prevention efforts within the first months of recovery from surgery. Choice of antiplatelet and anticoagulation, or even absence of therapy after first GIB does not seem to impact the rates of repeat bleeding.