NYMC Faculty Publications

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

Author Type(s)

Faculty

DOI

10.1016/j.cpcardiol.2021.100835

Journal Title

Current Problems in Cardiology

First Page

100835

Last Page

100835

Document Type

Review Article

Publication Date

11-2021

Department

Medicine

Keywords

Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Gastrointestinal Hemorrhage, Heart Failure, Heart-Assist Devices, Humans, Network Meta-Analysis, Retrospective Studies, Secondary Prevention

Disciplines

Medicine and Health Sciences

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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