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Gastrointestinal Bleeding in Left Ventricular Assist Device: Octreotide and Other Treatment Modalities

Tara L Molina1, Jill C Krisl, Kevin R Donahue

  • 1From the Department of Pharmacy, Houston Methodist Hospital (HMH), Houston, Texas.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|February 7, 2018
PubMed

Insights

Left ventricular assist devices (LVADs) can cause gastrointestinal bleeding (GIB). Octreotide shows promise in managing this complication by targeting factors like altered blood flow and platelet function.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Pharmacology

Background:

  • Left ventricular assist devices (LVADs) are crucial for end-stage heart failure but increase gastrointestinal bleeding (GIB) risk.
  • High shear and nonpulsatile flow from continuous-flow LVADs contribute to GIB via arteriovenous malformations and acquired von Willebrand syndrome.

Purpose of the Study:

  • To review the pathophysiology of LVAD-associated GIB.
  • To discuss current and novel treatment modalities for LVAD-associated GIB.
  • To evaluate the role of octreotide in managing LVAD-associated GIB.

Main Methods:

  • Literature review of LVADs, GIB pathophysiology, and treatment strategies.
  • Analysis of studies investigating octreotide for LVAD-GIB.
  • Synthesis of data on octreotide's pharmacologic effects relevant to GIB.

Main Results:

  • LVADs induce physiological changes predisposing to GIB.
  • Octreotide's mechanisms (e.g., improved platelet aggregation, reduced splanchnic flow) may counteract these changes.
  • Existing literature suggests clinical benefit of octreotide in managing LVAD-associated GIB.

Conclusions:

  • LVAD-associated GIB is a significant complication requiring effective management strategies.
  • Octreotide presents a promising therapeutic option, targeting key pathophysiological mechanisms.
  • Further research and clinical trials are warranted to solidify octreotide's role.

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