Experience of the use of octreotide for refractory gastrointestinal bleeding in a patient with Jarvik2000® left ventricular assist device

Seiko Nakajima-Doi, Osamu Seguchi, Yasuhiro Shintani, Tomoyuki Fujita, Satsuki Fukushima, Yorihiko Matsumoto, Yuka Eura, Koichi Kokame, Shigeki Miyata, Sachi Matsuda, Hiroki Mochizuki, Keiichiro Iwasaki, Yuki Kimura, Koichi Toda, Yuto Kumai, Kensuke Kuroda, Takuya Watanabe, Masanobu Yanase, Junjiro Kobayashi, Norihide Fukushima

研究成果: Article査読

1 被引用数 (Scopus)

抄録

Gastrointestinal bleeding (GIB) is among the major complications affecting implantable continuous-flow left ventricular assist device (iLVAD) recipients and is the major cause of re-hospitalization. GIB in iLVAD recipients is sometimes critical, and controlling bleeding using conventional approaches is difficult. A 35-year-old woman developed refractory GIB from multiple gastric polyps and de novo angiodysplasia after Jarvik2000® iLVAD implantation. Discontinuation of anticoagulation and antiplatelet therapies had little effect on GIB; thus, multiple endoscopic hemostatic therapies were performed. However, bleeding recurred several times, and red blood cell (RBC) transfusion in large volumes was required for progressive anemia. Furthermore, the von Willebrand factor (VWF) multimer analysis revealed loss of the high-molecular weight multimer, which may have resulted from the high-speed rotation of the axial-flow LVAD pump. To supplement VWF, cryoprecipitate was administered, but it was effective for only several days. Finally, the patient was treated with octreotide, a somatostatin analog, on post-operative day 58. After starting octreotide, tarry stool gradually decreased, and progression of anemia slowed down within the first 14 days of treatment; thus, the total RBC transfusion volume was reduced without additional hemostatic interventions, including cryoprecipitate administration. The patient developed mediastinitis on post-operative day 68 and died of sepsis on post-operative day 72. There was no adverse effect associated with octreotide use. Although the observation period was short, octreotide appears to be useful for resolving recurrent GIB after iLVAD implantation and reducing blood transfusions.

本文言語English
ページ(範囲)334-337
ページ数4
ジャーナルJournal of Artificial Organs
22
4
DOI
出版ステータスPublished - 01-12-2019
外部発表はい

All Science Journal Classification (ASJC) codes

  • 医学(その他)
  • 生体材料
  • 生体医工学
  • 循環器および心血管医学

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