Novel Use of Low-dose Thalidomide in Refractory Gastrointestinal Bleeding in Left Ventricular Assist Device Patients. Issue 11 (November 2017)

• Record Type: Journal Article
• Authors: Seng, Benjamin J.J.; Teo, Louis L.Y.; Chan, Laura L.; Sim, David K.L.; Kerk, Ka L.; Soon, Jia L.; Tan, Teing E.; Sivathasan, Cumaraswamy; Lim, Choon P.
• Is Part Of: International journal of artificial organs. Volume 40:Issue 11(2017:Nov.)
• Page Start: 636
• Page End: 640
• Publication Date: 2017-11
• Subjects: Left ventricular assist device -- Refractory gastrointestinal bleed -- Thalidomide; Artificial organs -- Periodicals; 617.956
• DOI: 10.5301/ijao.5000620
• Languages: English
• ISSNs: 0391-3988

Abstract

Background: Gastrointestinal bleeding (GIB) is a complication reported in patients post left ventricular assist device (LVAD) implantation that is associated with high mortality rates. Thalidomide is an anti-angiogenic compound that may offer a potential option for management of refractory LVAD-related GIB. Methods: A single-center, retrospective review was conducted from January 2009 to October 2016 at a tertiary cardiology center. It included LVAD patients initiated on thalidomide for refractory GIB. Results: All patients (n = 11) were started on thalidomide 50 mg nocte and there was resolution of GIB in all patients except one (90.9%) during initial thalidomide treatment. The median duration of thalidomide therapy was 98 days (interquartile range: 34–215). The dose of thalidomide was reduced for 2 patients due to adverse effects. Thalidomide therapy was discontinued in 6 patients due to cessation of GIB (n = 4) and adverse effects (n = 2). Reported adverse effects included LVAD thrombosis (n = 2), somnolence (n = 1), neuropathy (n = 1), constipation (n = 1), and transaminitis (n = 1). Recurrent GIB occurred in 4 patients (45.4%) post-discontinuation of thalidomide therapy, which led to the re-initiation of therapy. Conclusions: Thalidomide appears to be a safe and effective option for management of refractory LVAD-related GIB. Monitoring for recurrent GIB should be performed closely following cessation of thalidomide therapy.