Key result
Post-implant phosphodiesterase-5 inhibitors in LVAD patients reduced all-cause mortality (OR 0.92; 95% CI 0.85-0.98; p=0.02) and thrombotic events, but increased gastrointestinal bleeding.
Why the study?
Despite advancements in LVAD technology, hemocompatibility-related events remain a significant issue, creating a need to evaluate the safety and efficacy of post-implant PDE-5i.
Does post-implant PDE-5i reduce all-cause mortality in patients with left ventricular assist device?
Meta-Analysis
Does post-implant PDE-5i reduce all-cause mortality in patients with left ventricular assist device?
Odds Ratio: 0.92 (95% CI 0.85–0.98)
p-value: p=0.02
Post-implant PDE-5i use in LVAD patients is associated with reduced mortality and thrombotic events, but increases the risk of gastrointestinal bleeding.
Background: Despite the improvement in left ventricular assist device (LVAD) technology and the advent of third-generation LVADs, hemocompatibility-related events remain a significant issue. Therefore, new pharmacological treatments are necessary to optimize patient management and to further reduce hemocompatibility-related events. The purpose of the present systematic review and meta-analysis was to summarize the existing data regarding the safety and efficacy of post-implant phosphodiesterase-5 inhibitors (PDE-5i) on hemocompatibility-related events. Methods: Among the 258 articles in Pubmed, Scopus, and CENTRAL that were retrieved (1990−2022), 15 studies were included in the qualitative synthesis, and 9 studies were included in the quantitative synthesis. The fixed-effects model was used because it is statistically sound for combining a very small number of studies. The primary endpoint of the study was all-cause mortality, whereas the secondary endpoints were ischemic stroke, pump thrombosis, and gastrointestinal bleeding. Results: Mortality was significantly lower in the PDE-5i group vs. the control group (OR: 0.92 [95% CI: 0.85, 0.98]; p = 0.02). The secondary endpoints ischemic stroke (OR: 0.87 [95% CI: 0.78, 0.98]; p = 0.02) and pump thrombosis (OR: 0.90 [95% CI: 0.82, 0.99]; p = 0.04) were also lower in the PDE-5i group. The incidence of gastrointestinal bleeding was significantly higher in patients with LVAD receiving PDE-5i (OR: 1.26 [95% CI: 1.11, 1.44]; p < 0.01). In the overall analysis, the heterogeneity of outcomes was low, except for pump thrombosis. Conclusions: The use of PDE-5i post-implant was associated with lower mortality and thrombotic events but with a higher risk of gastrointestinal bleeding.
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Xanthopoulos et al. (2022) conducted a meta-analysis in Left Ventricular Assist Device (LVAD). Phosphodiesterase-5 inhibitors (PDE-5i) vs. Control was evaluated on All-cause mortality (OR 0.92, 95% CI 0.85, 0.98, p=0.02). Post-implant phosphodiesterase-5 inhibitors in LVAD patients reduced all-cause mortality (OR 0.92; 95% CI 0.85-0.98; p=0.02) and thrombotic events, but increased gastrointestinal bleeding.
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