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Bleeding with the artificial heart: Gastrointestinal hemorrhage in CF-LVAD patients.
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2017 Jun 14; Vol. 23 (22), pp. 3945-3953. - Publication Year :
- 2017
-
Abstract
- Continuous-flow left ventricular assist devices (CF-LVADs) have significantly improved outcomes for patients with end-stage heart failure when used as a bridge to cardiac transplantation or, more recently, as destination therapy. However, its implantations carries a risk of complications including infection, device malfunction, arrhythmias, right ventricular failure, thromboembolic disease, postoperative and nonsurgical bleeding. A significant number of left ventricular assist devices (LVAD) recipients may experience recurrent gastrointestinal hemorrhage, mainly due to combination of antiplatelet and vitamin K antagonist therapy, activation of fibrinolytic pathway, acquired von Willebrand factor deficiency, and tendency to develop small intestinal angiodysplasias due to increased rotary speed of the pump. Gastrointestinal bleeding in LVAD patients remains a source of increased morbidity including the need for blood transfusions, extended hospital stays, multiple readmissions, and overall mortality. Management of gastrointestinal bleeding in LVAD patients involves multidisciplinary approach in stabilizing the patients, addressing risk factors and performing structured endoluminal evaluation with focus on upper gastrointestinal tract including jejunum to find and eradicate culprit lesion. Medical and procedural intervention is largely successful and universal bleeding cessation occurs in transplanted patients.<br />Competing Interests: Conflict-of-interest statement: The authors have no conflict of interest related to the manuscript.
- Subjects :
- Angiodysplasia history
Angiodysplasia mortality
Angiodysplasia therapy
Animals
Anticoagulants adverse effects
Blood Coagulation
Gastrointestinal Hemorrhage history
Gastrointestinal Hemorrhage mortality
Gastrointestinal Hemorrhage therapy
Heart Failure history
Heart Failure mortality
Heart Failure physiopathology
Heart-Assist Devices history
History, 20th Century
History, 21st Century
Humans
Platelet Aggregation Inhibitors adverse effects
Prosthesis Design
Recovery of Function
Risk Assessment
Risk Factors
Treatment Outcome
Angiodysplasia etiology
Gastrointestinal Hemorrhage etiology
Heart Failure therapy
Heart-Assist Devices adverse effects
Ventricular Function, Left
Subjects
Details
- Language :
- English
- ISSN :
- 2219-2840
- Volume :
- 23
- Issue :
- 22
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Review
- Accession number :
- 28652649
- Full Text :
- https://doi.org/10.3748/wjg.v23.i22.3945