Mechanisms of gastrointestinal bleeding in LVAD-supported patients: A two-hit model of hemostatic disruption and pathologic angiogenesis

Gastrointestinal bleeding is the most frequent adverse event in patients with advanced heart failure supported by a left ventricular assist device (LVAD). In addition to contributing to increased morbidity and mortality, recurrent bleeding often necessitates blood transfusions, which can lead to human leukocyte antigen (HLA) sensitization-thereby narrowing the pool of compatible donor organs and heightening the risk of graft rejection after transplantation. Angiodysplasias are the most common source of gastrointestinal bleeding in this population, yet its underlying mechanisms remain incompletely understood. In this review, we synthesize current knowledge on the pathophysiology of angiodysplasia-related bleeding in LVAD recipients and propose mechanistically informed treatment strategies tailored to individual pathophysiological profiles.