Acid Suppression to Prevent Gastrointestinal Bleeding in Patients with Ventricular Assist Devices

Abby W. Hickman, Nick W. Lonardo, Mary C. Mone, Angela P. Presson, Chong Zhang, Richard G. Barton, Craig H Selzman, Stavros George Drakos, Antigone Koliopoulou, Stephen H. McKellar

Research output: Contribution to journalArticle

Abstract

Background: 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 (PPIs) or histamine receptor antagonists (H2RA) for preventing GIB in patients with VAD. Materials and methods: The surgical ICU and VAD databases within a large regional academic cardiac mechanical support and transplant center were queried for patients who underwent VAD implantation between 2010 and 2014. An observational cohort study was conducted to identify which acid suppressing drug regimen was associated with the fewest number of GIB events within 30 d after VAD implantation: PPI, H2RA, or neither. Secondary outcomes included timing, etiology, and location of GIB. Multivariable logistic regression was used to compare treatment cohorts to GIB. Odds ratios, 95% confidence intervals, and P-values were reported from the model. Results: One hundred thirty-eight patients were included for final analysis, 19 of which had a GIB within 30 days of VAD implantation. Both H2RA and PPI use were associated with reduced GIB compared with the cohort with no acid suppressive therapy. In the multivariate analysis, the PPI cohort showed a statistically significant reduction in GIB (Odds ratio 0.18 [95% confidence interval 0.04-0.79] P = 0.026). Conclusions: Using PPI postoperatively in patients with new VAD was associated with a reduced incidence of GIB. Given that GIB is a known complication after VAD placement, clinicians should consider the use of acid suppressive therapy for primary prevention.

LanguageEnglish (US)
Pages96-102
Number of pages7
JournalJournal of Surgical Research
Volume234
DOIs
StatePublished - Feb 1 2019

Fingerprint

Heart-Assist Devices
Hemorrhage
Acids
Proton Pump Inhibitors
Odds Ratio
Confidence Intervals
Histamine Receptors
Histamine Antagonists
Incidence
Primary Prevention
Observational Studies
Cohort Studies
Therapeutics
Multivariate Analysis
Logistic Models
Databases
Transplants

Keywords

  • Acid suppression
  • Cardiothoracic surgery
  • Gastrointestinal bleed
  • Mechanical circulatory support
  • Stress ulcer prophylaxis
  • Ventricular assist device

ASJC Scopus subject areas

  • Surgery

Cite this

Acid Suppression to Prevent Gastrointestinal Bleeding in Patients with Ventricular Assist Devices. / Hickman, Abby W.; Lonardo, Nick W.; Mone, Mary C.; Presson, Angela P.; Zhang, Chong; Barton, Richard G.; Selzman, Craig H; Drakos, Stavros George; Koliopoulou, Antigone; McKellar, Stephen H.

In: Journal of Surgical Research, Vol. 234, 01.02.2019, p. 96-102.

Research output: Contribution to journalArticle

Hickman, Abby W. ; Lonardo, Nick W. ; Mone, Mary C. ; Presson, Angela P. ; Zhang, Chong ; Barton, Richard G. ; Selzman, Craig H ; Drakos, Stavros George ; Koliopoulou, Antigone ; McKellar, Stephen H. / Acid Suppression to Prevent Gastrointestinal Bleeding in Patients with Ventricular Assist Devices. In: Journal of Surgical Research. 2019 ; Vol. 234. pp. 96-102.
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abstract = "Background: 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 (PPIs) or histamine receptor antagonists (H2RA) for preventing GIB in patients with VAD. Materials and methods: The surgical ICU and VAD databases within a large regional academic cardiac mechanical support and transplant center were queried for patients who underwent VAD implantation between 2010 and 2014. An observational cohort study was conducted to identify which acid suppressing drug regimen was associated with the fewest number of GIB events within 30 d after VAD implantation: PPI, H2RA, or neither. Secondary outcomes included timing, etiology, and location of GIB. Multivariable logistic regression was used to compare treatment cohorts to GIB. Odds ratios, 95{\%} confidence intervals, and P-values were reported from the model. Results: One hundred thirty-eight patients were included for final analysis, 19 of which had a GIB within 30 days of VAD implantation. Both H2RA and PPI use were associated with reduced GIB compared with the cohort with no acid suppressive therapy. In the multivariate analysis, the PPI cohort showed a statistically significant reduction in GIB (Odds ratio 0.18 [95{\%} confidence interval 0.04-0.79] P = 0.026). Conclusions: Using PPI postoperatively in patients with new VAD was associated with a reduced incidence of GIB. Given that GIB is a known complication after VAD placement, clinicians should consider the use of acid suppressive therapy for primary prevention.",
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AU - Hickman, Abby W.

AU - Lonardo, Nick W.

AU - Mone, Mary C.

AU - Presson, Angela P.

AU - Zhang, Chong

AU - Barton, Richard G.

AU - Selzman, Craig H

AU - Drakos, Stavros George

AU - Koliopoulou, Antigone

AU - McKellar, Stephen H.

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N2 - Background: 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 (PPIs) or histamine receptor antagonists (H2RA) for preventing GIB in patients with VAD. Materials and methods: The surgical ICU and VAD databases within a large regional academic cardiac mechanical support and transplant center were queried for patients who underwent VAD implantation between 2010 and 2014. An observational cohort study was conducted to identify which acid suppressing drug regimen was associated with the fewest number of GIB events within 30 d after VAD implantation: PPI, H2RA, or neither. Secondary outcomes included timing, etiology, and location of GIB. Multivariable logistic regression was used to compare treatment cohorts to GIB. Odds ratios, 95% confidence intervals, and P-values were reported from the model. Results: One hundred thirty-eight patients were included for final analysis, 19 of which had a GIB within 30 days of VAD implantation. Both H2RA and PPI use were associated with reduced GIB compared with the cohort with no acid suppressive therapy. In the multivariate analysis, the PPI cohort showed a statistically significant reduction in GIB (Odds ratio 0.18 [95% confidence interval 0.04-0.79] P = 0.026). Conclusions: Using PPI postoperatively in patients with new VAD was associated with a reduced incidence of GIB. Given that GIB is a known complication after VAD placement, clinicians should consider the use of acid suppressive therapy for primary prevention.

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