Effect of Angiotensin II Antagonism on Gastrointestinal Bleeding in Patients With Left Ventricular Assist Devices: A Systematic Review and Meta-Analysis

The importance of medical therapy to ameliorate the incidence and impact of left ventricular assistance device-related gastrointestinal bleeding has been highlighted recently with several single-center studies. Electronic databases were searched for studies that compared the incidence of gastrointestinal bleeding for those people on left ventricular assist support with and without angiotensin II inhibition. Angiotensin II inhibition was associated with a lower incidence of gastrointestinal bleeding (pooled RR 0.58, 95% confidence interval (CI): 0.34-0.98; p = 0.04], with a trend toward toward lower incidence with arteriovenous malformation-associated gastrointestinal bleeding (pooled RR 0.50, 95% CI: 0.25-1.03; p = 0.06).