Octreotide for the Management of Gastrointestinal Bleeding in Patients with Continuous-Flow Left Ventricular Assist Device

Background: Gastrointestinal bleeding (GIB) is one of the most common complications after continuous-flow left ventricular assist device (LVAD) implantation. Octreotide, a somatostatin analog, is proposed to reduce the risk of recurrent GIB in this population. The mechanisms involved in this pharmacological effect of octreotide include: increased vascular resistance, improved platelet aggregation, and inhibition of angiogenesis via inhibition of VEGF.

Objectives: We describe our experience with the use of octreotide for the management of GIB in the LVAD population.

Results: Of 90 patients implanted with a continuous-flow LVAD at our institution, 6 had GIB unresponsive to conventional management and were started with chronic octreotide injections, either twice daily (0.1mg) or once a month (10 mg). Four patients with single GIB event were free from GIB with long term octreotide in spite of full dose aspirin and coumadin (INR range 2-3). An attempt of discontinue octreotide in 2 of these patients has resulted in recurrent GIB 7-10 days later, with resolution after reinitiating the treatment. Two patients had recurrent GIB necessitating hospitalizations and multiple blood transfusions, as well as discontinuation of aspirin and coumadin. Octreotide therapy has resolved GIB in one patient, allowing reinitiating coumadin at a therapeutic dose. The second patient had significant reduction in the frequency of hospitalizations and blood transfusions with long term octreotide, and although aspirin and coumadin were discontinued for more than 2 years, LVAD hemodynamic performance has been stable with no signs of thrombosis.

Conclusions: Our data suggests that octreotide may be a feasible option for LVAD patients with GIB and may improve morbidity, prevent recurrent hospitalizations and the need for blood transfusions which improve the risk for possible sensitization.