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Angiotensin II antagonists and gastrointestinal bleeding in left ventricular assist devices: A systematic review and

Veraprapas Kittipibul1, Wasawat Vutthikraivit2, Jakrin Kewcharoen3

  • 1Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA.

The International Journal of Artificial Organs
|August 27, 2020
PubMed

Insights

Angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) significantly reduced gastrointestinal bleeding (GIB) in patients with continuous-flow left ventricular assist devices (CF-LVAD). This suggests ACEI/ARB may mitigate CF-LVAD complications by suppressing angiogenesis.

Area of Science:

  • Cardiovascular Medicine
  • Gastroenterology
  • Pharmacology

Background:

  • Gastrointestinal bleeding (GIB), particularly from arteriovenous malformations (AVM), is a serious complication after continuous-flow left ventricular assist device (CF-LVAD) implantation.
  • Angiotensin II pathway inhibitors, such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), may reduce GIB and AVM-related GIB by inhibiting angiogenesis.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis evaluating the association between ACEI/ARB treatment and GIB in the CF-LVAD population.

Main Methods:

  • A comprehensive literature search was performed through December 2019.
  • Included studies compared GIB and/or AVM-related GIB events in LVAD patients who received ACEI/ARB versus those who did not.
  • Data were combined using random-effects models to calculate pooled odds ratios (OR) and 95% confidence intervals (CI).

Main Results:

  • Three retrospective cohort studies involving 619 CF-LVAD patients (467 on ACEI/ARB) were analyzed.
  • ACEI/ARB use was significantly associated with a decreased incidence of overall GIB (pooled OR 0.35, 95% CI 0.22-0.56, p < 0.001).
  • A trend towards a lower risk of AVM-related GIB was observed with ACEI/ARB use, though not statistically significant (pooled OR 0.46, 95% CI 0.19-1.07, p = 0.07).

Conclusions:

  • ACEI/ARB treatment is associated with a significant reduction in overall GIB among CF-LVAD patients.
  • Further research with larger studies and precise definitions is needed to confirm the non-hemodynamic benefits of ACEI/ARB in mitigating GIB and AVM-related GIB in this population.

Keywords:
Angiotensin II antagonistsarteriovenous malformationsgastrointestinal hemorrhageleft ventricular assist device

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