SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients - 21/08/20

Doi : 10.1016/j.hlc.2019.07.011

George Mawardi, MD ^a, Tim M. Markman, MD ^b, Rahatullah Muslem, BSc ^c, Minoosh Sobhanian, PharmD ^d, Maureen Converse, PharmD ^d, Holly B. Meadows, PharmD ^d, Walter E. Uber, PharmD ^d, Stuart D. Russell, MD ^e,^f, Rosanne Rouf, MD ^f, Bhavadharini Ramu, MD ^g, Daniel P. Judge, MD ^f,^g, Ryan J. Tedford, MD ^f,^g, Brian A. Houston, MD ^f,^g,⁎
^a Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
^b Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
^c Thoraxcenter, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
^d Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA
^e Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
^f Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
^g Medical University of South Carolina, Division of Cardiology, Charleston, SC, USA

^⁎Corresponding author at: Mechanical Circulatory Support, 114 Doughty Street, MSC 592, BM222, Charleston, SC 29425, USA. Tel.: 843 876 4787; Fax: 843 876 4990.Mechanical Circulatory Support114 Doughty Street, MSC 592BM222CharlestonSC29425USA

Résumé

Background

Gastrointestinal bleeding (GIB) is common in left ventricular assist device (LVAD) patients. Serotonin release from platelets promotes platelet aggregation, and selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI) therapy inhibits the transporter responsible for re-uptake.

Methods

We reviewed the records of LVAD (HeartMateII™, Abbott Medical, Lake Bluff, IL, USA and Heartware™, Medtronic, Minneapolis, MN, USA) patients at the Medical University of South Carolina and Johns Hopkins Hospital between January 2009 and January 2016. After exclusions, 248 patients were included for analysis. After univariate analysis, logistic regression multivariate analysis was performed to adjust for any demographic, cardiovascular, and laboratory data variables found to be associated with GI bleeding post-LVAD.

Results

Gastrointestinal bleeding occurred in 85 patients (35%) with 55% of GIBs due to arteriovenous malformations (AVMs). Of the total cohort, 105 patients received an SSRI or SNRI during LVAD support. Forty-four (44) SSRI/SNRI (41.9%) and 41 non-SSRI/SNRI (28.7%) patients had a GIB (RR 1.46, p = 0.03). Twenty-six (26) (24.8%) of the SSRI/SNRI patients had a GIB due to AVMs versus 21 (14.7%) of the non-SSRI/SNRI patients (RR 1.69, p = 0.05). In fully-adjusted multivariate regression analysis, SSRI/SNRI therapy was independently associated with GIB (OR 1.78, p = 0.045). For GIB, the number needed to harm (NNH) was 7.6.

Conclusion

In conclusion, SSRI/SNRI therapy is independently associated with an increased risk of GIB in LVAD patients.

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Keywords : LVAD, GI bleeding, SSRI, SNRI

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Vol 29 - N° 8

P. 1241-1246 - août 2020 Retour au numéro

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SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients - 21/08/20

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