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Association of bleeding with serotonergic antidepressants in patients receiving left ventricular assist device

Adam C Robinson1, Spenser E January1, Kent W Botkin1

  • 1Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA.

Pharmacotherapy
|October 16, 2021
PubMed

Insights

Use of antiplatelet agents (SAs) in patients with continuous-flow left ventricular assist devices (CF-LVADs) was linked to a higher incidence of bleeding events, particularly gastrointestinal bleeds. Further research is needed to explore SA risks and antithrombotic strategies.

Area of Science:

  • Cardiology
  • Medical Devices
  • Pharmacology

Background:

  • Continuous-flow left ventricular assist devices (CF-LVADs) are crucial for patients with advanced heart failure.
  • Antiplatelet agents (SAs) are often prescribed to CF-LVAD patients to prevent device thrombosis.
  • The association between SA use and bleeding risk in this population requires further investigation.

Purpose of the Study:

  • To determine if SA use is associated with an increased risk of bleeding events in patients receiving CF-LVAD support.
  • To compare bleeding incidence between CF-LVAD patients who received SAs and those who did not.

Main Methods:

  • Retrospective cohort analysis of adult patients implanted with CF-LVADs (HVAD™, HeartMate II™, HeartMate 3™) between July 2009 and October 2018.
  • Patients were stratified into two groups: those receiving SAs (n=203) and those not receiving SAs (n=391).
  • Primary outcome was the incidence of the first bleeding event (gastrointestinal bleed, epistaxis, or intracerebral hemorrhage) from 30 days to 18 months post-implantation.

Main Results:

  • A significantly higher proportion of patients on SAs experienced bleeding events (45.8%) compared to the control group (32.2%) (p=0.001).
  • After adjusting for covariates, SA use remained independently associated with an increased risk of bleeding (adjusted odds ratio: 1.75, p=0.002).
  • HeartMate 3™ patients had a lower adjusted odds of bleeding compared to HeartMate II™ patients (adjusted odds ratio: 0.46, p=0.024).

Conclusions:

  • SA use is associated with a higher incidence of first bleeding events in CF-LVAD patients, primarily driven by gastrointestinal bleeds.
  • The findings suggest a need for careful consideration of SA use and potential adjustments to antithrombotic strategies in CF-LVAD recipients.
  • Further research is warranted to assess differential bleeding risks among various SA agents and optimize antithrombotic management.
Abstract

Keywords:
antidepressantassistbleedingdevicegastrointestinalserotonergicventricular

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