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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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| Published in: | Journal of cardiovascular translational research 2021-06, Vol.14 (3), p.484-491 |
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| container_end_page | 491 |
| container_issue | 3 |
| container_start_page | 484 |
| container_title | Journal of cardiovascular translational research |
| container_volume | 14 |
| creator | Plazak, Michael E. Hankinson, Stephen J. Sorensen, Erik N. Reed, Brent N. Ravichandran, Bharath Ton, Van-Khue |
| description | 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.
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| doi_str_mv | 10.1007/s12265-020-10084-7 |
| format | article |
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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</description><identifier>ISSN: 1937-5387</identifier><identifier>EISSN: 1937-5395</identifier><identifier>DOI: 10.1007/s12265-020-10084-7</identifier><identifier>PMID: 33175315</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>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</subject><ispartof>Journal of cardiovascular translational research, 2021-06, Vol.14 (3), p.484-491</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-e121f989628ddb259a879c34c71aea934f9a41d3915341efc934c2242f2181ec3</citedby><cites>FETCH-LOGICAL-c347t-e121f989628ddb259a879c34c71aea934f9a41d3915341efc934c2242f2181ec3</cites><orcidid>0000-0001-8616-4724</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33175315$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Plazak, Michael E.</creatorcontrib><creatorcontrib>Hankinson, Stephen J.</creatorcontrib><creatorcontrib>Sorensen, Erik N.</creatorcontrib><creatorcontrib>Reed, Brent N.</creatorcontrib><creatorcontrib>Ravichandran, Bharath</creatorcontrib><creatorcontrib>Ton, Van-Khue</creatorcontrib><title>Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices</title><title>Journal of cardiovascular translational research</title><addtitle>J. of Cardiovasc. Trans. Res</addtitle><addtitle>J Cardiovasc Transl Res</addtitle><description>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</description><subject>Adult</subject><subject>Biomedical Engineering and Bioengineering</subject><subject>Biomedicine</subject><subject>Cardiology</subject><subject>Erythrocyte Transfusion</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - diagnosis</subject><subject>Gastrointestinal Hemorrhage - etiology</subject><subject>Gastrointestinal Hemorrhage - prevention & control</subject><subject>Heart-Assist Devices - adverse effects</subject><subject>Hemostatics - therapeutic use</subject><subject>Human Genetics</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Prosthesis Implantation - adverse effects</subject><subject>Prosthesis Implantation - instrumentation</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Secondary Prevention</subject><subject>Tamoxifen - therapeutic use</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1937-5387</issn><issn>1937-5395</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kMlOBCEQhonRuL-AB8PRSytL99Ac3TWZqDHqlSBdKKanUYp2eXvRUY9eKIr66g_5CNnibJczpvaQCzFpKiZYVfq2rtQCWeVaqqqRuln8u7dqhawhPjE2EUypZbIiJVeN5M0qGS_iK_T0FoFGT2_sLL4HDwPNkV5DNzooxY0pwZDpqcWcYhgyYA6D7elBD9CF4YGGgV7ZHAqE9C3kRzoFn-ld6VNwY28T3UcMmOkRvAYHuEGWvO0RNn_qOrk9Ob45PKuml6fnh_vTysla5Qq44F63eiLarrsXjbat0mXkFLdgtay9tjXvpOaNrDl4V56cELXwgrccnFwnO_Pc5xRfxvJtMwvooO_tAHFEI-qmhMtyFFTMUZciYgJvnlOY2fRhODNfus1ctym6zbduo8rS9k_-eD-D7m_l128B5BzAMhoeIJmnOKbiDv-L_QRFo4ub</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Plazak, Michael E.</creator><creator>Hankinson, Stephen J.</creator><creator>Sorensen, Erik N.</creator><creator>Reed, Brent N.</creator><creator>Ravichandran, Bharath</creator><creator>Ton, Van-Khue</creator><general>Springer US</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8616-4724</orcidid></search><sort><creationdate>20210601</creationdate><title>Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices</title><author>Plazak, Michael E. ; Hankinson, Stephen J. ; Sorensen, Erik N. ; Reed, Brent N. ; Ravichandran, Bharath ; Ton, Van-Khue</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-e121f989628ddb259a879c34c71aea934f9a41d3915341efc934c2242f2181ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Biomedical Engineering and Bioengineering</topic><topic>Biomedicine</topic><topic>Cardiology</topic><topic>Erythrocyte Transfusion</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - diagnosis</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Gastrointestinal Hemorrhage - prevention & control</topic><topic>Heart-Assist Devices - adverse effects</topic><topic>Hemostatics - therapeutic use</topic><topic>Human Genetics</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Prosthesis Implantation - adverse effects</topic><topic>Prosthesis Implantation - instrumentation</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Secondary Prevention</topic><topic>Tamoxifen - therapeutic use</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Plazak, Michael E.</creatorcontrib><creatorcontrib>Hankinson, Stephen J.</creatorcontrib><creatorcontrib>Sorensen, Erik N.</creatorcontrib><creatorcontrib>Reed, Brent N.</creatorcontrib><creatorcontrib>Ravichandran, Bharath</creatorcontrib><creatorcontrib>Ton, Van-Khue</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular translational research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Plazak, Michael E.</au><au>Hankinson, Stephen J.</au><au>Sorensen, Erik N.</au><au>Reed, Brent N.</au><au>Ravichandran, Bharath</au><au>Ton, Van-Khue</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices</atitle><jtitle>Journal of cardiovascular translational research</jtitle><stitle>J. of Cardiovasc. Trans. Res</stitle><addtitle>J Cardiovasc Transl Res</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>14</volume><issue>3</issue><spage>484</spage><epage>491</epage><pages>484-491</pages><issn>1937-5387</issn><eissn>1937-5395</eissn><abstract>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.
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| identifier | ISSN: 1937-5387 |
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| 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 |
| title | Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices |
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