Angiotensin II antagonists and gastrointestinal bleeding in left ventricular assist devices: A systematic review and meta-analysis. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Kittipibul, Veraprapas; Vutthikraivit, Wasawat; Kewcharoen, Jakrin; Rattanawong, Pattara; Tantrachoti, Pakpoom; Putthapiban, Prapaipan; Nair, Nandini
• Is Part Of: International journal of artificial organs. Volume 44:Issue 3(2021)
• Page Start: 215
• Page End: 220
• Publication Date: 2021-03
• Subjects: Angiotensin II antagonists -- gastrointestinal hemorrhage -- arteriovenous malformations -- left ventricular assist device; Artificial organs -- Periodicals; 617.956
• DOI: 10.1177/0391398820951811
• Languages: English
• ISSNs: 0391-3988

Abstract

Gastrointestinal bleeding (GIB) especially from arteriovenous malformations (AVM) remains one of the devastating complications following continuous-flow left ventricular device (CF-LVAD) implantation. Blockade of angiotensin II pathway using angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) was reported to mitigate the risk of GIB and AVM-related GIB by suppressing angiogenesis. We performed a systematic review and meta-analysis to evaluate the association between ACEI/ARB treatment and GIB in CF-LVAD population. Comprehensive literature search was performed through December 2019. We included studies reporting risk of GIB and/or AVM-related GIB events in LVAD patients who received ACEI/ARB with those who did not. Data from each study were combined using the random-effects to calculate odd ratios and 95% confidence intervals. Three retrospective cohort studies were included in this meta-analysis involving 619 LVADs patients (467 patients receiving ACEI/ARB). The use of ACEI/ARB was statistically associated with decreased incidence of overall GIB (pooled OR 0.35, 95% CI 0.22–0.56, I 2 = 0.0%, p < 0.001). There was a non-significant trend toward lower risk for AVM-related GIB in patients who received ACEI/ARB (pooled OR 0.46, 95% CI 0.19–1.07, I 2 = 51%, p = 0.07). Larger studies with specific definitions of ACEI/ARB use and GIB are warranted to accurately determine the potential non-hemodynamic benefits of ACEI/ARB in CF-LVAD patients.