Efficacy of Long-Acting Octreotide in Left Ventricular Assist Device Patients with Recurrent Gastrointestinal Bleeding

T. Wilson¹, D. Baran², J. Herre², C. Cameron¹, W. Old³, G. Zeevi², C. Barreiro⁴, C. Kemp⁴, J. Philpott⁴, A. Ingemi⁵

¹Pharmacy Department, Sentara Norfolk General Hospital, Norfolk, VA, ²Advanced Heart Failure Department, Sentara Norfolk General Hospital, Norfolk, VA, ³Bayview Cardiovascular Associates, Norfolk, VA, ⁴Division of Cardiothoracic Surgery, Sentara Norfolk General Hospital, Norfolk, VA, ⁵Department of Pharmacy, Sentara Norfolk General Hospital, Norfolk, VA

Meeting: 2019 American Transplant Congress

Abstract number: B124

Keywords: Blood transfusion, Heart assist devices, Ventricular assist devices

Session Information

Session Name: Poster Session B: Heart and VADs: All Topics

Session Type: Poster Session

Date: Sunday, June 2, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Continuous flow ventricular assist device (VAD) patients have a high risk of recurrent gastrointestinal bleeding, often leading to readmission and morbidity. Intramuscular long-acting octreotide (LAO) has been reported to reduce this complication in case reports and a case-control with the HMII device. A cohort of outpatient LAO use with various devices has never been evaluated. We evaluated the efficacy of LAO for prevention of recurrent gastrointestinal bleeds (GIB) in outpatients with VADs.

*Methods: This retrospective study evaluated the incidence of GIB prior to and after initiation of LAO in patients with a VAD. All patients who experienced at least one GIB post VAD implant and received at least one dose of LAO were included. In our program, all patients after VAD implantation start on aspirin 325mg and warfarin with an INR target of 2-3. The primary endpoint was the frequency of GIBs expressed as bleeds requiring hospital admission per 100 patient-months prior to LAO initiation and post-LAO initiation.

*Results: Patients (N = 30; ages 46 – 74) all received LAO every 21 or 28 days with doses ranging from 20 to 40 mg. The patient population consisted of 77% males, 14 patients had a HeartWare, 13 patients had a HeartMate II, and 3 patients had a HeartMate III. The average octreotide dose was 26.38 ± 7.2mg and dosing frequency was every 27 ± 3.1 days. 90% of patients had a decrease in the frequency of GIB admissions after initiation of LAO (Figure 1). Patients had an average of 2.07 GIB admissions pre-LAO compared with 0.57 GIB admissions post-LAO (p<0.001). Patients were followed for a similar amount of time pre- and post-LAO (465 vs. 504 days; p=0.701). Numerically more patients pre-LAO were treated with a reduced antiplatelet (60% vs. 43%; p=0.332) and an INR goal reduction (63% vs. 33%; p=0.078). The frequency of GIBs was significantly higher pre-LAO compared with post-LAO (29.7 vs. 5.87 GIB per 100 patient-months; p <0.001).

*Conclusions: LAO therapy resulted in significantly fewer admissions for GI bleeding. 90% of patients responded with decreased bleeding frequency. Additional and larger studies are still warranted to strengthen the results.

To cite this abstract in AMA style:

Wilson T, Baran D, Herre J, Cameron C, Old W, Zeevi G, Barreiro C, Kemp C, Philpott J, Ingemi A. Efficacy of Long-Acting Octreotide in Left Ventricular Assist Device Patients with Recurrent Gastrointestinal Bleeding [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/efficacy-of-long-acting-octreotide-in-left-ventricular-assist-device-patients-with-recurrent-gastrointestinal-bleeding/. Accessed November 24, 2024.

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