digoxin and Gastrointestinal-Hemorrhage

Topics: Bacterial Vaccines; Bicarbonates; Brain Edema; Diagnosis, Differential; Diazepam; Digoxin; Fever; Gastrointestinal Hemorrhage; Heparin; Humans; Hydrocortisone; Infant; Infant, Newborn; Isoproterenol; Mannitol; Meningitis; Meningitis, Meningococcal; Meningitis, Viral; Phenytoin; Seizures; Shock, Septic; Vitamin K

We aimed to assess the impact of digoxin use following left ventricular assist device (LVAD) implantation on clinical outcomes.. Patients implanted with continuous flow LVADs at a single academic medical center and survived to initial hospital discharge were included in the analysis (. Digoxin use was associated with reduction in GIB events, but not in RVF or mortality. Further studies are needed to confirm these findings and to investigate optimal timing and patient population.

Topics: Adult; Aged; Digoxin; Female; Gastrointestinal Hemorrhage; Heart Failure; Heart-Assist Devices; Hemoglobins; Humans; Male; Middle Aged; Neprilysin; Potassium; Receptors, Angiotensin; Retrospective Studies; Risk Factors

Assess the association between digoxin use and gastrointestinal bleeding (GIB) in a multicenter continuous flow left ventricular assist device (LVAD) cohort.. 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.. 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).. 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.

Topics: Digoxin; Enzyme Inhibitors; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Heart Failure; Heart-Assist Devices; Humans; Male; Middle Aged; Registries; Retrospective Studies; United States

Gastrointestinal bleeding (GIB) is one of the principal adverse events affecting patients with continuous-flow left ventricular assist devices (CF-LVADs). Despite the early recognition that GIB is commonly because of gastrointestinal angiodysplasia (GIAD), the exact pathophysiology of this process remains elusive. It has been postulated that the abnormal hemodynamic profile in CF-LVAD patients may activate the angiogenesis signaling cascade via the HIF (hypoxia-inducible factor)-1α/angiopoietin-2 pathway leading to formation of GIADs. Digoxin is a potent inhibitor of HIF-1α synthesis, and we hypothesized that its use reduces the incidence of GIAD and GIB in patients with CF-LVAD.. Charts of all adult patients implanted with CF-LVAD between February 2006 and February 2017 were reviewed with particular emphasis on occurrence and cause of GIB. Fifty-four of 199 patients (27%) experienced a GIB. Overall frequency of GIB was lower in the 64 patients receiving digoxin compared with the 135 patients not receiving digoxin (16% versus 33%, P=0.01). Multivariable-adjusted Cox regression analysis confirmed that digoxin use was independently associated with a reduced risk for overall GIB (hazard ratio, 0.49; 95% CI, 0.24-0.98; P=0.045). GIBs were then categorized as non-GIAD, GIAD, or likely GIAD. Although the incidence of non-GIAD was similar in both groups (11% versus 7%, P=0.41), the frequency of GIAD/likely GIAD bleeding was significantly reduced in the digoxin group (5% versus 25%, P=0.0003). Multivariable-adjusted analysis confirmed that digoxin use was independently associated with a reduced risk for GIAD/likely GIAD bleeding (hazard ratio, 0.18; 95% CI, 0.06-0.6; P=0.005). However, digoxin use was not associated with reduced risk for non-GIAD GIB (hazard ratio, 1.54; 95% CI, 0.58-4.08; P=0.39).. Use of digoxin was associated with a significant reduction in GIAD-related GIB in patients with CF-LVAD.

Topics: Adult; Aged; Angiodysplasia; Cardiotonic Agents; Digoxin; Female; Gastrointestinal Hemorrhage; Heart Failure; Heart-Assist Devices; Humans; Male; Middle Aged; Prosthesis Design; Protective Factors; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Ventricular Function, Left

Topics: Acute Disease; Cardiotonic Agents; Digitalis Glycosides; Digoxin; Fatal Outcome; Female; Gastrointestinal Hemorrhage; Humans; Infant; Intestine, Small; Necrosis

Topics: Adenocarcinoma; Aged; Atrial Fibrillation; Blood Transfusion; Cephalothin; Digoxin; Disseminated Intravascular Coagulation; Gangrene; Gastrointestinal Hemorrhage; Gentamicins; Heparin; Humans; Hydronephrosis; Hypothermia; Lymphatic Metastasis; Male; Prostatic Neoplasms; Pyelonephritis; Stomach Neoplasms; Vitamin K

Topics: Aged; Alcoholism; Allopurinol; Arrhythmias, Cardiac; Chloral Hydrate; Colchicine; Digoxin; Drug Synergism; Gastrointestinal Hemorrhage; Gout; Hospitals, Teaching; Humans; Liver Diseases; Male; Middle Aged; Nitroglycerin; Patient Care Team; Pharmacists; Pharmacy Service, Hospital; Quinidine; Warfarin; Washington