GI Bleed After LVAD Predicts Risk of Thromboembolic Events

Patients who experience gastrointestinal bleeding within 30 days of receiving a left ventricular assist device (LVAD) have a higher risk of thromboembolic (TE) events, according to a recent study. However, this risk was lower in African American patients.

Findings were presented by Eric W. Rudofker and colleagues at the Heart Failure Society of America (HFSA) 21st Annual Scientific Meeting, which took place from September 16 to 19, 2017, in Dallas, Texas.
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Patients who received LVAD are commonly treated with warfarin and aspirin to prevent pump thrombosis and ischemic stroke. However, bleeding complications, especially gastrointestinal bleeding, are prevalent among patients with LVAD. Little is currently known about the association between gastrointestinal bleeding and thromboembolic events in these patients.

For their study, the researchers evaluated patients who had received a HeartMate II continuous-flow LVAD at a single center from January 2011 to March 2014. Mean patient age was 58.3 years, 83% of patients were male, and 83% of patients were white. Median follow-up lasted 387 days.

The researchers defined gastrointestinal bleeding as an admission requiring at least blood transfusion or an endoscopic procedure, and a TE event as confirmed or suspected pump thrombosis leading to removal of LVAD and/or mortality, or ischemic stroke. The primary outcome was a TE event. Hazard ratios and confidence intervals were calculated via Cox proportional hazards modeling in a recurrent events framework.

Results of the multivariate model indicated that patients with LVAD had a significantly higher risk of a TE event 30 days after a gastrointestinal bleed. This risk was also higher in patients with a history of smoking. However, African-American patients demonstrated a significantly lower adjusted rate of TE events.

“[Gastrointestinal bleeding] in the previous 30 days was a strong predictor of TE events among LVAD patients,” the researchers concluded. “African-American race may be protective against TE events in LVAD patients.”

—Christina Vogt

Reference:

Rudofker EW, Sherazi S, Rice JD, Johnson BA, Alexis JD. Increased risk of thromboembolic events following gastrointestinal bleeds among left ventricular assist device patients. J Cardiac Failure. 2017;23(8):S56.  http://dx.doi.org/10.1016/j.cardfail.2017.07.156.