Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices

Gastrointestinal bleeding (GIB) is a frequent complication in patients with continuous-flow left ventricular assist devices (LVAD). We retrospectively evaluated eight patients implanted with a HeartWare LVAD between July 2017 and June 2020 who experienced at least one episode of GIB and were started...

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Bibliographic Details
Published in:Journal of cardiovascular translational research 2021-06, Vol.14 (3), p.484-491
Main Authors: Plazak, Michael E., Hankinson, Stephen J., Sorensen, Erik N., Reed, Brent N., Ravichandran, Bharath, Ton, Van-Khue
Format: Article
Language:English
Subjects:
Adult
Biomedical Engineering and Bioengineering
Biomedicine
Cardiology
Erythrocyte Transfusion
Female
Gastrointestinal Hemorrhage - diagnosis
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - prevention & control
Heart-Assist Devices - adverse effects
Hemostatics - therapeutic use
Human Genetics
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Original Article
Prosthesis Implantation - adverse effects
Prosthesis Implantation - instrumentation
Recurrence
Retrospective Studies
Secondary Prevention
Tamoxifen - therapeutic use
Time Factors
Treatment Outcome
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Summary:Gastrointestinal bleeding (GIB) is a frequent complication in patients with continuous-flow left ventricular assist devices (LVAD). We retrospectively evaluated eight patients implanted with a HeartWare LVAD between July 2017 and June 2020 who experienced at least one episode of GIB and were started on tamoxifen 20 mg once daily for secondary prevention. Tamoxifen was associated with a significant decrease in major GIB from a median of 3 (IQR 1.4–7) events/patient-year pre-tamoxifen initiation to 0 (IQR 0–0.9) events/patient-year post-tamoxifen initiation ( p  = 0.02). Transfusion of packed red blood cells also decreased from 16.8 (IQR 9.9–30.6) units/patient-year pre-tamoxifen initiation to 1.5 (IQR 0–7.5) units/patient-year post-tamoxifen ( p  = 0.04). Tamoxifen was well tolerated and no thromboembolic complications were observed. This small cohort study suggests that tamoxifen is associated with reduced GIB and transfusion requirements, with no apparent increase in thrombotic risk. A larger, randomized study is warranted to confirm the results of this exploratory analysis. Graphical abstract
ISSN:1937-5387
1937-5395
DOI:10.1007/s12265-020-10084-7