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Gastrointestinal angiodysplasia is associated with significant gastrointestinal bleeding in patients with continuous
Justin Cochrane1, Christian Jackson2, Greg Schlepp3
1Assistant Clinical Associate Professor University of Washington Medical School, Providence Sacred Heart Medical Center Internal Medicine Residency Spokane, Washington, United States.
Insights
Gastrointestinal angiodyplasia (GIAD) in patients with continuous-flow left ventricular assist devices (LVADs) leads to more bleeding events and transfusions. GIAD significantly increases major bleeding risk compared to other gastrointestinal bleeding sources in LVAD patients.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Devices
Background:
- Continuous-flow left ventricular assist devices (LVADs) are associated with a high incidence of bleeding events, particularly gastrointestinal bleeding (GIB).
- Gastrointestinal angiodyplasia (GIAD) is a common cause of GIB in LVAD patients, but its specific impact on bleeding severity and management is not fully elucidated.
Purpose of the Study:
- To determine if GIAD in LVAD patients is associated with a higher rate of significant bleeding.
- To compare the number of bleeding events per year and transfusion rates between GIAD and non-GIAD sources of GIB.
- To identify risk factors for increased bleeding in LVAD patients with GIAD.
Main Methods:
- Retrospective cohort study of 118 patients who received a continuous-flow LVAD.
- Patients were categorized into GIB and non-GIB groups, with GIB further classified by source (GIAD, obscure, non-GIAD).
- Analysis included comparison of demographics, comorbidities, laboratory data, bleeding severity, re-bleeding rates, and transfusion requirements.
Main Results:
- GIAD was associated with a significantly higher number of bleeding events (2.07 vs. 1.23) and bleeding events per year (0.806 vs. 0.455) compared to non-GIAD sources.
- Patients with GIAD experienced a higher incidence of major bleeding (100% vs. 60%) and required more transfusions (8.8 vs. 2.95 units).
- Cox Regression identified age, chronic kidney disease, and prolonged hospital stay (>45 days) as risk factors for increased bleeding, while hypertension, diabetes, and male gender were associated with decreased risk.
Conclusions:
- GIAD in continuous-flow LVAD patients is linked to a greater likelihood of major bleeding, recurrent bleeding episodes, and increased transfusion needs.
- Understanding GIAD as a specific cause of GIB in LVAD recipients is crucial for managing bleeding complications and optimizing patient outcomes.
- Risk stratification incorporating factors like age and comorbidities may aid in predicting and mitigating bleeding events in this population.
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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