Serotonergic Antidepressants and Hospitalization for Bleeding in Patients with LVAD

Abstracts Methods: A single center retrospective review was performed on adult patients between 2011 and 2017 for patients receiving LVAD and having a GIB event within 1 year after implantation. The types of procedure, clinical findings, and endoscopy results were recorded. Results: We included 54 subjects, accounting for 164 endoscopies from 111 GIB events. The most utilized exam was upper GI endoscopy (UGE; 50% of all procedures). Diagnostic yield leading to treatment was highest for double balloon enteroscopy (DBE) (65%; Fig 1A) and lowest for UGE (40%) with similar frequencies for lesion identification (Fib 1B). There were 50 patients presenting with their first GIB concerning for an upper GI source, of which 42 received UGE. A lesion was identified in 25 (50%) of these cases, and treatment administered in 13 (25%). For subsequent endoscopy procedures, diagnostic yield for push enteroscopy (PE) was 76% and 71% for DBE. There were 28 (52%) patients that had re-bleeding within 1 year; the median number of bleeding events per person was 2 [1, 2.75] and the median number of endoscopies needed per person was 2 [2, 4]. There were 117 (71%) endoscopies that identified culprit lesions and 79 (48%) resulted in 1 or more treatment. Median LOS for patients who received DBE was 8 days, compared to 5 days for those with no DBE. Conclusion: Initial endoscopic evaluation with DBE or PE rather than UGE would serve to increase the yield of finding a culprit lesion and decrease LOS in patients with LVAD admitted for GIB. Additional studies to identify patients at high risk of recurrent GIB are needed.

S193 dysfunction and is associated with an increased risk of bleeding across diverse populations. There is limited data on the bleeding risk with SAs in the LVAD population prone to hemorrhagic complications due to other mechanisms. Methods: We performed a retrospective analysis of LVAD patients (pts) managed at our institution from January 2016 to August 2018. Pertinent demographics and clinical variables related to bleeding were collected at the time of discharge from LVAD implantation and on admission for a bleeding event. Pts were divided into those prescribed an SA at discharge from LVAD implantation or admitted for a bleeding event with documented SA use prior to admission (Group 1) and those without SA exposure after implant (Group 2). Primary and secondary endpoints included incidence of bleeding requiring hospitalization, time from implant to first hospitalization for a bleeding event, and incidence rate of hospitalizations for bleeding per patient years. Results: A preliminary analysis of 20 randomly selected pts out of 95 total implants performed. Ten pts were prescribed an SA (Group 1) and 10 were not (Group 2). Baseline demographics and bleeding risk factors were similar between the (two) 2 groups. Trazodone and sertraline were the most commonly prescribed SAs (35% each) and multiple SA use was common (50%). Acid suppressive therapy was used in all pts at discharge. In Group 1, 50% of the pts were hospitalized for a bleeding event compared to 10% of pts in Group 2 (p=0.1). At 1 year, 60% of pts remained free from hospitalization for a bleeding event in Group 1 compared to 100% in Group 2 (p=0.16). The number of bleeds per patient-year in Group 1 vs. those in Group 2 was 0.79 vs 0.4, respectively (p=0.26). Gastrointestinal (6 vs. 3 events) and intracranial (2 vs. 0 events) bleeding was more common in Group 1. Conclusion: A preliminary analysis of patients with an LVAD treated with SA therapy demonstrated a trend towards an increased rate of hospitalization due to bleeding and a shorter time to first hospitalization compared to those who were not treated with an SA. Our final analysis will expand to all 95 patients to determine the significance of these findings.

458 Correlation of Thromboelastography Parameters with Bleeding Episodes of Post-LVAD Surgery P. Tantrachoti, P. Pachariyanon, W. Vutthikraivit, B. Hirsch and N. Nair. Texas Tech University Health Sciences Center, Lubbock, TX.

457 Serotonergic Antidepressants and Hospitalization for Bleeding in Patients with LVAD K. Behrend,1 M.P. Lillyblad,1 P. Skelton,1 R.F. Gaberich,2 K. Wilson,2 P.M. Eckman,3 B. Sun,3 and K. Hryniewicz.3 1Abbott Northwestern Hospital, Minneapolis, MN; 2Minneapolis Heart Institute Foundation, Minneapolis, MN; and the 3Minneapolis Heart Institute, Minneapolis, MN. Purpose: Serotonergic antidepressants (SA) are commonly used for a variety of indications in patients supported with durable left ventricular assist devices (LVAD). Reduced serotonin reuptake with SAs leads to platelet

Purpose: Left ventricular assist device (LVAD) is considered as an alternative treatment for patients with refractory end-stage heart failure. Perioperative bleeding is one of the most common adverse events of LVAD surgery. Thromboelastography (TEG; Haemoscope, Niles, IL, USA), a commercial assay that assesses clot formation, has been shown to reduce blood product use in cardiac surgeries. However, the information in LVAD surgery is very minimal. We aim to assess the statistical correlation between TEG parameters and bleeding during perioperative period. Methods: We conducted a retrospective study of patients who underwent LVAD implantation at University Medical Center, Lubbock, Texas from July 1st, 2016 to July 31st, 2018. We excluded the patients whose TEG was not checked prior to LVAD surgery. We collected maximal amplitude of clot formation in response to arachidonic acid (MAAA), clot strength (GAA) and bleeding outcomes. Results: Sixteen LVAD patients were included in the study with mean age of 57.2§8.2 years old (see table 1 for baseline characteristics and lab values). MAAA and GAA showed significant negative correlation with surgical drain output, number of packed red cell units and number of platelet units (p = 0.04, 0.04 and 0.01 respectively for MAAA and p = 0.04, 0.03 and 0.01 respectively for GAA). MAAA and GAA also showed moderate negative correlation with length of hospital stay and episodes of surgical re-exploration due to bleeding (r = -0.47 and -0.42 for MAAA and r = -0.43 and -0.42 for GAA) although without statistical significance (p ≥ 0.05). Conclusion: Our study found that TEG parameters correlated significantly with drain output, number of packed red cell and platelet units used during perioperative period. They also tended to correlate with the hospital length