Key result
Octreotide prophylaxis in LVAD patients is linked to a ~44% reduction in recurrent GI bleeding.
Why the study?
Does octreotide secondary prophylaxis reduce recurrent gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices?
Cohort (n=51)
Yes
Does octreotide secondary prophylaxis reduce recurrent gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices?
Octreotide used as secondary prophylaxis may significantly reduce the high rate of recurrent gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices.
Octreotide was associated with fewer recurrent GI bleeds in LVAD patients; leaves open confirmation in prospective trials.
Background Gastrointestinal (GI) bleeding is one of the most common complications after continuous-flow left ventricular assist device implantation. More than one third of patients with incident bleed go on to develop recurrent GI bleeding. Octreotide, a somatostatin analog, is proposed to reduce the risk of recurrent GI bleeding in this population. Methods and Results This multicenter, retrospective analysis evaluated 51 continuous-flow left ventricular assist device patients who received secondary prophylaxis with octreotide after their index GI bleed from 2009 to 2015. All patients had a hospitalization for GI bleed and received octreotide after discharge. Patient demographics, medical and medication history, and clinical characteristics of patients who rebled after receiving octreotide were compared with non–rebleeders. These data were also compared with matched historical control patients previously enrolled in the HMII (HeartMate II) clinical trials, none of whom received octreotide, to provide a context for the bleeding rates. Twelve patients (24%) who received secondary octreotide prophylaxis developed another GI bleed, whereas 39 (76%) did not. There were similar intergroup demographics; however, significantly more bleeders had a previous GI bleeding history before left ventricular assist device placement (33% versus 5%; P =0.02) and greater frequency of angiodysplasia confirmed during endoscopy (58% versus 23%; P =0.03). Fewer patients in this study experienced a recurrent GI bleed compared with a matched historical control group that did not receive octreotide (24% versus 43%; P =0.04). Conclusions Patients with continuous-flow left ventricular assist device receiving secondary prophylaxis with octreotide had a significantly lower GI bleed recurrence compared with historical controls not treated with octreotide. Additional prospective studies are needed to confirm these data.
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Shah et al. (2017) conducted a cohort in Left ventricular assist device and gastrointestinal bleeding (n=51). Octreotide vs. Matched historical controls not receiving octreotide was evaluated on Recurrent GI bleeding (p=0.04). Secondary prophylaxis with octreotide in patients with left ventricular assist devices was associated with lower recurrent GI bleeding compared with historical controls (24% vs 43%; P=0.04).
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