Primary and Secondary Prevention Strategies for Gastrointestinal Bleeding in Patients with Left Ventricular Assist Device: A Systematic Review and Network Meta-analysis

Abstract Recurrent gastrointestinal bleeding (GIB) is a common complication following left ventricular assist device (LVAD) implantation. Our study aimed to estimate the comparative efficacy of different pharmacologic interventions for the prevention of GIB, through a network meta-analysis. A total of 13 observational studies comparing six strategies. Among those, 4 were for primary, and 9 were for secondary prevention of GIB. On network meta-analysis, thalidomide [Hazard ratio (HR): 0.016, Credible interval (CrI)I: 0.00053-0.12], omega-3-fatty acid [HR:0.088, CrI: 0.026-0.77], octreotide [HR: 0.17, CrI: 0.0589-0.41] and danazol [HR:0.17, CrI: 0.059-0.41] reduced the risk of GIB. The use of angiotensin-converting enzyme inhibitors /angiotensin II receptor blocker (ACEi/ARB) and digoxin were not associated with any significant reduction. Based on network meta-analysis, combining indirect treatment comparisons, thalidomide, danazol, and octreotide treatments were associated with decreased risk of recurrent GIB. Additionally, Omega 3 fatty acids were associated with a lower risk of the primary episode of GIB in the LVAD patient population.