Primary and Secondary Prevention Strategies for Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device: A Systematic Review and Network Meta-analysis

Devesh Rai; Raseen Tariq; Muhammad Waqas Tahir; Medhat Chowdhury; Abdul Wahab; Adnan Kharsa; Dhrubajyoti Bandyopadhyay; Scott Feitell; Vishal Parikh; Wilbert S. Aronow; Gregg M. Lanier; Elliot J. Levine; Gregg C. Fonarow; Vivek Kaul

doi:10.1016/j.cpcardiol.2021.100835

Primary and Secondary Prevention Strategies for Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device: A Systematic Review and Network Meta-analysis

Devesh Rai, Raseen Tariq, Muhammad Waqas Tahir, Medhat Chowdhury, Abdul Wahab, Adnan Kharsa, Dhrubajyoti Bandyopadhyay, Scott Feitell, Vishal Parikh, Wilbert S. Aronow, Gregg M. Lanier, Elliot J. Levine, Gregg C. Fonarow, Vivek Kaul

In: Current Problems in Cardiology · 2021 · vol. 46(11) , pp. 100835 · doi:10.1016/j.cpcardiol.2021.100835 · PMID:33992428 · W3151740680

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This network meta-analysis compared six pharmacologic interventions for gastrointestinal bleeding prevention in LVAD patients, finding thalidomide, omega-3 fatty acids, octreotide, and danazol significantly reduced GIB risk.

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Abstract

Recurrent gastrointestinal bleeding (GIB) is a common complication following left ventricular assist device (LVAD) implantation. Our study aimed to estimate the comparative efficacy of different pharmacologic interventions for the prevention of GIB, through a network meta-analysis (NMA). A total of 13 observational studies comparing six strategies. Among those, 4 were for primary, and 9 were for secondary prevention of GIB. On NMA, thalidomide (Hazard ratio [HR]: 0.016, Credible interval [CrI]I: 0.00053-0.12), omega-3-fatty acid (HR:0.088, CrI: 0.026-0.77), octreotide (HR: 0.17, CrI: 0.0589-0.41) and danazol (HR:0.17, CrI: 0.059-0.41) reduced the risk of GIB. The use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker (ACEi/ARB) and digoxin were not associated with any significant reduction. Based on NMA, combining indirect treatment comparisons, thalidomide, danazol, and octreotide treatments were associated with decreased risk of recurrent GIB. Additionally, Omega 3 fatty acids were associated with a lower risk of the primary episode of GIB in the LVAD patient population.

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Su1395 INITIATION OF DANAZOL IN LEFT VENTRICULAR ASSIST DEVICE PATIENTS WITH RECURRENT GI BLEEDING LEADS TO SHORTER HOSPITAL STAYS AND FEWER BLOOD TRANSFUSIONS via openalex
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[1] Danazol as a Treatment to Reduce Reoccurrence of Hospitalization for Gastrointestinal Bleeding in Patient with Continuous Flow Left Ventricular Assist Device 2016

[2] Su1395 INITIATION OF DANAZOL IN LEFT VENTRICULAR ASSIST DEVICE PATIENTS WITH RECURRENT GI BLEEDING LEADS TO SHORTER HOSPITAL STAYS AND FEWER BLOOD TRANSFUSIONS 2019