A. W. Hickman1, N. W. Lonardo1, M. C. Mone1, A. P. Presson1, C. Zhang1, R. G. Barton1, S. H. McKellar1, C. H. Selzman1 1University Of Utah,Salt Lake City, UT, USA
Introduction: The high incidence of gastrointestinal bleeding (GIB) in patients with ventricular assist devices (VAD) is well known, but there is limited evidence to support the use of proton pump inhibitors (PPI) or histamine receptor antagonists (H2RA) for preventing GIB in patients who require treatment for their cardiac disease with VAD implantation.
Methods: The institutional Surgical and Cardiovascular ICU and VAD databases within an academic cardiac mechanical support and transplant center were queried for patients who underwent VAD implantation between 2010 and 2014. The devices included HeartWare, HeartMate II, Jarvik 2000, or SynCardia TAH devices and could be used for left, right or both-sided failure. An observational cohort study was conducted on the final population to identify which prophylactic acid suppressing drug regimen was associated with the fewest number of GIB events within 30-days after VAD implantation: PPI or H2RA, or no acid suppressing therapy. Secondary outcomes included an evaluation of the timing, etiology, and location of all GIB events. Univariate and multivariate regression was performed using clinically important covariates. A combined variable for pre-existing GIB risk was created based on history of GIB and previous use of acid suppressive medication. Based on the number of GIB events, the acid suppressing treatment and three other covariates were used in the final model.
Results: There were a total of 138 patients included for analysis, 19 (13.8%) of which had a GIB event within the 30-day period. Both H2RA and PPI use were associated with a reduction in GIB events when compared to no acid suppressive therapy. In the logistic regression analysis controlling for ICU admission APACHE II score, preoperative hematocrit, and pre-existing GIB risk, the PPI cohort had a statistically significant reduction in GIB [OR 0.18 (0.04-0.79) p=0.026] (see table).
Conclusion: This review of patients with newly implanted VAD revealed that the use of acid suppressing therapy during the postoperative ICU period resulted in fewer GIB events. When controlling for severity of illness and known risks for bleeding, those patients treated with a PPI had a statistically lower risk for GIB. Cardiothoracic surgeons and ICU clinicians should consider this treatment option in order to reduce complications for this high-risk subset of patients.
