Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices
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ORIGINAL ARTICLE
Novel Use of Tamoxifen to Reduce Recurrent Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices Michael E. Plazak 1 Van-Khue Ton 2,5
&
Stephen J. Hankinson 2 & Erik N. Sorensen 3 & Brent N. Reed 4 & Bharath Ravichandran 1 &
Received: 16 July 2020 / Accepted: 3 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Gastrointestinal bleeding (GIB) is a frequent complication in patients with continuous-flow left ventricular assist devices (LVAD). We retrospectively evaluated eight patients implanted with a HeartWare LVAD between July 2017 and June 2020 who experienced at least one episode of GIB and were started on tamoxifen 20 mg once daily for secondary prevention. Tamoxifen was associated with a significant decrease in major GIB from a median of 3 (IQR 1.4–7) events/patient-year pretamoxifen initiation to 0 (IQR 0–0.9) events/patient-year post-tamoxifen initiation (p = 0.02). Transfusion of packed red blood cells also decreased from 16.8 (IQR 9.9–30.6) units/patient-year pre-tamoxifen initiation to 1.5 (IQR 0–7.5) units/patient-year post-tamoxifen (p = 0.04). Tamoxifen was well tolerated and no thromboembolic complications were observed. This small cohort study suggests that tamoxifen is associated with reduced GIB and transfusion requirements, with no apparent increase in thrombotic risk. A larger, randomized study is warranted to confirm the results of this exploratory analysis. Keywords Tamoxifen . Continuous-flow left ventricular assist device . Gastrointestinal bleeding . Angiodysplasia
HHT ICM INR INTERMACS
Abbreviations ACE-I ARB ASA AV AVM BTC BTT CAD CKD GIB HF
IQR LVAD NICM OHT PAP PFA PRBC RV TATR TBTR TEG TTR
Angiotensin-converting enzyme inhibitor Angiotensin II receptor blocker Aspirin Aortic valve Arteriovenous malformation Bridge to candidacy Bridge to transplant Coronary artery disease Chronic kidney disease Gastrointestinal bleeding Heart failure
Hereditary hemorrhagic telangiectasia Ischemic cardiomyopathy International normalized ratio Interagency Registry for Mechanically Assisted Circulatory Support Interquartile range Left ventricular assist device Non-ischemic cardiomyopathy Orthotopic heart transplant Pulmonary artery pressure Platelet function analyzer Packed red blood cell Right ventricular Time above therapeutic range Time below therapeutic range Thromboelastography Time in therapeutic range
Associate Editor Navin Kumar Kapur oversaw the review of this article * Michael E. Plazak [email protected] 1
2
University of Maryland Medical Center, 22 South Greene Street, Suite 400, Baltimore, MD 21201, USA Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
3
Division of Perioperative Services, University of Maryland Medical Center, Baltimore, MD, USA
4
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
5
Harvard Medical School, Division of Cardiology, Massachusetts Genera
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