Contributor: Nick Hawkes
CF-LVAD patients experience high rates of gastrointestinal (GI) bleeding. A multicenter, retrospective analysis by Shah et al demonstrated that patients with a prior GI bleed after CF-LVAD implantation had a lower rate (24% vs 43%) of recurrent GI bleed when receiving octreotide.
Fifty-one patients were identified from 5 participating centers. All patients had one previous GI bleed following CF-LVAD implantation, and received octreotide treatment for at least 6 months following index GI bleed. Octreotide was dosed as a monthly depot injection in 72% of patients or twice daily subcutaneous injection in 28%. Shah et al used a comparison group of HMII CF-LVAD patients who had experienced a GI bleed in clinical trials using HMII bridge-to-transplant (BTT) and destination therapy (DT). Patients were propensity matched based on HF etiology, CF-LVAD indication, CF-LVAD support time, sex, and age. Of the 51 CF-LVAD patients analyzed, 50% were DT. Twelve patients (24%) who received octreotide experienced a recurrent bleed vs 22 (43%) of the comparison group (p<0.04).
The patients who received octreotide and had a recurrent GI bleed were more likely to have angiodysplasia on endoscopy (p<0.03) with more severe bleeding during the index bleed. Additionally, the recurrent GI bleed group had a higher rate of GI bleeds prior to CF-LVAD placement (p<0.02).
No study is perfect. Comparison of the octreotide group with a historical comparator group introduces potential selection bias and may not account for historical differences in treatment. Also, there was no standard octreotide dosing regimen or compliance assessment. But this is an interesting, hypothesis-generating analysis.