Association between digoxin use and gastrointestinal bleeding in contemporary continuous flow left ventricular assist device support

Abdelghani El Rafei, Barry H. Trachtenberg, Jessica Schultz, Ranjit John, Jerry D. Estep, Raquel Araujo-Gutierrez, T. Eric E. Suarez, Kevin Goodwin, Rebecca Cogswell

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Assess the association between digoxin use and gastrointestinal bleeding (GIB) in a multicenter continuous flow left ventricular assist device (LVAD) cohort. Methods: Patients implanted with continuous flow LVADs with data on GIB and digoxin use from two centers were included in the analysis (n = 649). GIB events were captured up to 2 years of follow-up. 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 the association between digoxin use and number of GIB events over the follow-up period. Results: Mean age of the cohort was 57 years (±14) and 45% (293/649) were bridge to transplant (BTT). Digoxin was prescribed in 33% of patients. Digoxin use was associated with an unadjusted 32% reduction in the incidence of rate of all cause GIB (IRR 0.68, 95% CI 0.46-0.99, p = 0.049). After adjusting for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, renal function, and implanting center there was still a 34% reduction in the incidence rate (IRR 0.67, 95% CI 0.45-0.99, p = 0.048). When limiting the analysis to those with likely arteriovenous malformation associated GIB, the association strengthened (unadjusted: IRR 0.48, 95 % CI 0.26-0.89, p = 0.02, adjusted: IRR 0.47, 95 % CI 0.25-0.9, p = 0.022). Conclusions: In this multicenter study, inclusive of contemporary devices, digoxin use was associated with reduced GIB events. Prospective data will be required to confirm this association.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
Early online dateMar 4 2021
DOIs
StateE-pub ahead of print - Mar 4 2021

Bibliographical note

Funding Information:
This study is funded by University of Minnesota departmental funds.

Publisher Copyright:
© 2021

Keywords

  • Digoxin
  • GI bleed
  • angiopoietin 2 (Ang2)
  • arteriovenous malformations (AVMs)
  • hypoxia-inducible factor 1-alpha (HIF-1a)
  • left ventricular assistive device (LVAD)

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