GI bleed with Continuous flow LVAD – Mechanisms

GI bleed with Continuous flow LVAD – Mechanisms

Gastrointestinal bleeds can occur in 15-40% of patients on continuous flow left ventricular assist devices (LVAD) for end stage heart failure. Proposed mechanisms for gastrointestinal bleeds with continuous flow LVAD includes:

1. Acquired von Willebrand disease
2. Impaired platelet aggregation
3. Enhanced angiogenesis causing arteriovenous malformations (AVM)
4. Intensity of anticoagulation

AVMs may contribute to about half of the GI bleed with continuous flow LVADS. Hypoperfusion of gastrointestinal mucosa leads to angiogenesis and the new friable vessels are prone for bleeding [1].

Reference

1. Guha A, Eshelbrenner CL, Richards DM, Monsour HP Jr. Gastrointestinal bleeding after continuous-flow left ventricular device implantation: review of pathophysiology and management. Methodist Debakey Cardiovasc J. 2015 Jan-Mar;11(1):24-7.