Association between digoxin use and gastrointestinal bleeding in contemporary continuous flow left ventricular assist...

Area of Science:

• Cardiology
• Gastroenterology
• Medical Devices

Background:

• Gastrointestinal bleeding (GIB) is a serious complication in patients with left ventricular assist devices (LVADs).
• The potential role of medications, such as digoxin, in modulating GIB risk in this population is not well understood.

Purpose of the Study:

• To assess the association between digoxin use and the incidence of gastrointestinal bleeding (GIB) in a multicenter cohort of patients with continuous flow left ventricular assist devices (LVADs).

Main Methods:

• A retrospective analysis of 649 patients with continuous flow LVADs from two centers was conducted.
• Digoxin use was defined as prescription at discharge or within 3 months post-implantation.
• A negative binomial regression model was used to evaluate the association between digoxin use and GIB events over a 2-year follow-up period, adjusting for relevant covariates.

Main Results:

• Digoxin use was associated with a 32% reduction in the unadjusted incidence rate of all-cause GIB (IRR 0.68, P=0.049).
• After multivariable adjustment, digoxin use remained associated with a 34% reduction in GIB incidence (IRR 0.67, P=0.048).
• The association was stronger when analyzing GIB likely related to arteriovenous malformations (adjusted IRR 0.47, P=0.022).

Conclusions:

• Digoxin use in patients with continuous flow LVADs is associated with a reduced incidence of gastrointestinal bleeding.
• These findings suggest a potential protective effect of digoxin against GIB in this high-risk population.
• Prospective studies are warranted to validate this association and elucidate the underlying mechanisms.