Association between Digoxin Use and Gastrointestinal Bleeding in Contemporary Continuous Flow Left Ventricular Assist Device Support

Abdelghani El Rafei, B. Trachetenberg, R. John, J. Estep, Jessica N Schultz, K. Goodwin, R. Araujo, Thenappan Thenappan, Rebecca J Cogswell

Research output: Contribution to journalArticle

Abstract

PURPOSE: Digoxin use has been associated with reduced rate of gastrointestinal bleeding (GIB) in a previous study of patients on left ventricular assistive device (LVAD) support. The purpose of this study was to test the association between digoxin use and GIB events in a large, multicenter, contemporary dataset inclusive of HeartMate 3 devices. METHODS: Patients with complete data on GIB events and digoxin use from two medical centers were included in the analysis (total n=650). GI bleeding events were captured out to 2 years of follow up and digoxin use was defined as digoxin prescribed at discharge or within the first 3 months after LVAD implantation. A negative binomial regression model was performed to determine association between digoxin use and number of GI bleeding events over 2 years of LVAD support. RESULTS: Mean age of the study cohort was 57 years (±14), 45 % were bridge to transplant (BTT), and 78% had HeartMate 2 devices. Thirteen % received HeartMate 3 devices. Digoxin was prescribed in 31% of patients. Patients on digoxin had better renal function at the time of LVAD implantation (1.19 vs 1.21, P= 0.037), lower INTERMACS profile (INTERMACS 2-3: 56 % vs. 48 %, P<0.001) and were less likely to be designated BTT (33% vs 51%, P < 0.001). Digoxin use was associated with a reduction in the incidence rate of GI bleeding on LVAD support (unadjusted 35% reduction in incidence rate ratio (IRR), 95% CI 3-56 % reduction, p =0.034, adjusted 36% reduction in IRR, 95% CI 3-58 % reduction, p =0.038). The final model was adjusted for age, INTERMACS profile, BTT status, creatinine, right atrial pressure and ace-inhibitor or angiotensin receptor blocker use. CONCLUSION: In this large multicenter study, inclusive of the most contemporary devices, digoxin use was associated with reduced GI bleeding events. Prospective data will be required to confirm this hypothesis.

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