Department of Pharmacy, University of Kentucky, Lexington, Kentucky.
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee.
Pharmacotherapy. 2017 Nov;37(11):1432-1448. doi: 10.1002/phar.2016. Epub 2017 Oct 10.
Continuous-flow left ventricular assist devices (CF-LVADs) have become an integral component of the management in patients with advanced heart failure, serving as destination therapy or as a bridge to heart transplantation. Despite significant advances in the design and longevity of the device, the ongoing risk for bleeding remains a significant concern. The genesis of gastrointestinal bleeding (GIB) in patients with CF-LVADs is likely multifactorial and may include components of acquired von Willebrand disease, angiodysplasia, and gastrointestinal arteriovenous malformations, as well as additional risk factors such as history of GIB and increased age. Several pharmacotherapy options have been used, but the data surrounding their overall efficacy remain sparse. The necessity for larger prospective studies is essential to further advance the management of this devastating complication. Within this review, we discuss the known pathophysiologic process of CF-LVAD-related GIB and highlight the therapeutic options discussed within the literature. In addition, we discuss potential therapeutic options based on mechanisms of action as they correlate to known pathophysiologic processes of CF-LVAD-related GIB. Finally, we provide recommendations for constructing drug therapy regimens in patients with CF-LVADs who develop GIB.
持续流动左心室辅助装置 (CF-LVAD) 已成为治疗晚期心力衰竭患者的重要组成部分，可作为终末期治疗或心脏移植的桥接治疗。尽管该设备在设计和使用寿命方面取得了重大进展，但持续存在的出血风险仍然是一个重大关注点。CF-LVAD 患者发生胃肠道出血 (GIB) 的原因可能是多因素的，可能包括获得性血管性血友病、血管扩张和胃肠道动静脉畸形的成分，以及其他危险因素，如 GIB 病史和年龄增加。已经使用了几种药物治疗选择，但围绕其整体疗效的数据仍然很少。因此，进行更大规模的前瞻性研究对于进一步推进这种破坏性并发症的治疗至关重要。在本综述中，我们讨论了 CF-LVAD 相关 GIB 的已知病理生理过程，并强调了文献中讨论的治疗选择。此外，我们根据与 CF-LVAD 相关 GIB 的已知病理生理过程相关的作用机制讨论了潜在的治疗选择。最后，我们为发生 GIB 的 CF-LVAD 患者制定药物治疗方案提供了建议。
