El Rafei Abdelghani, Trachtenberg Barry H, Schultz Jessica, John Ranjit, Estep Jerry D, Araujo-Gutierrez Raquel, Suarez T Eric E, Goodwin Kevin, Cogswell Rebecca
Department of Medicine, Division of Internal Medicine, University of Minnesota, Minneapolis, Minnesota.
Department of Heart Failure & Transplant Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Research Institute, Houston, Texas.
J Heart Lung Transplant. 2021 Jul;40(7):671-676. doi: 10.1016/j.healun.2021.03.005. Epub 2021 Mar 4.
Assess the association between digoxin use and gastrointestinal bleeding (GIB) in a multicenter continuous flow left ventricular assist device (LVAD) cohort.
Patients implanted with continuous flow LVADs with data on GIB and digoxin use from two centers were included in the analysis (n = 649). GIB events were captured up to 2 years of follow-up. Digoxin use was defined as digoxin prescribed at discharge or within the first 3 months after LVAD implantation. A negative binomial regression model was performed to determine the association between digoxin use and number of GIB events over the follow-up period.
Mean age of the cohort was 57 years (±14) and 45% (293/649) were bridge to transplant (BTT). Digoxin was prescribed in 33% of patients. Digoxin use was associated with an unadjusted 32% reduction in the incidence of rate of all cause GIB (IRR 0.68, 95% CI 0.46-0.99, p = 0.049). After adjusting for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, renal function, and implanting center there was still a 34% reduction in the incidence rate (IRR 0.67, 95% CI 0.45-0.99, p = 0.048). When limiting the analysis to those with likely arteriovenous malformation associated GIB, the association strengthened (unadjusted: IRR 0.48, 95 % CI 0.26-0.89, p = 0.02, adjusted: IRR 0.47, 95 % CI 0.25-0.9, p = 0.022).
In this multicenter study, inclusive of contemporary devices, digoxin use was associated with reduced GIB events. Prospective data will be required to confirm this association.
评估多中心持续血流左心室辅助装置（LVAD）队列中地高辛使用与胃肠道出血（GIB）之间的关联。
分析纳入了植入持续血流LVAD且有来自两个中心的GIB和地高辛使用数据的患者（n = 649）。随访长达2年以记录GIB事件。地高辛使用定义为出院时或LVAD植入后前3个月内开具的地高辛。采用负二项回归模型来确定随访期间地高辛使用与GIB事件数量之间的关联。
该队列的平均年龄为57岁（±14），45%（293/649）为过渡到移植（BTT）。33%的患者开具了地高辛。地高辛使用与全因GIB发生率未经调整的降低32%相关（发病率比[IRR] 0.68，95%置信区间[CI] 0.46 - 0.99，p = 0.049）。在调整年龄、性别、机构间机械辅助循环支持注册（INTERMACS）资料、肾功能和植入中心后，发病率仍降低34%（IRR 0.67，95% CI 0.45 - 0.99，p = 0.048）。当将分析局限于可能与动静脉畸形相关的GIB患者时，这种关联增强（未经调整：IRR 0.48，95% CI 0.26 - 0.89，p = 0.02；调整后：IRR 0.47，95% CI 0.25 - 0.9，p = 0.022）。
在这项纳入当代装置的多中心研究中，地高辛使用与GIB事件减少相关。需要前瞻性数据来证实这种关联。
