Sangramento gastrintestinal por angiodisplasia e estenose aórtica: síndrome de Heyde

S70

Heart, Lung and Circulation 2010;19S:S1–S268

Abstracts

ABSTRACTS

164

165

Facilitating Optimum Doses of Heart Failure Medications: Evaluation of a Heart Failure Medication Titration Form

Gastrointestinal Bleeding Due to Angiodysplasia in Patients With Continuous Flow Left Ventricular Assist Device

F. Chuan ∗ , R. Peters, T. Beswick, M. Weglowski, D. Korczyk Princess Alexandra Hospital, Australia Background: Previous studies have found suboptimal prescribing of ACE-inhibitors and Beta-blockers in patients with heart failure. Princess Alexandra Hospital Heart Failure Service (PAHHFS) offers optimisation of HF medications with pharmacist review, nurse practitioner titration clinics and general practitioner liaison. In 2008, a HF Medication Titration Form was adapted from other facilities and introduced. Aims: To evaluate: • the use of ACE-inhibitors/angiotensin-2 receptor blockers (ACEI/ARB) and Beta-blockers in patients with left ventricular systolic failure, and • the use of the PAH HF Medication Titration Form. Method: 100 consecutive patients enrolled in PAHHFS were reviewed. Data were collected as part of routine care. Results: Most patients had a HF Medication Titration Form completed on discharge, unless contraindicated. HF medication doses were significantly higher at follow-up.

Conclusion: Patients were appropriately identified for HF medication titration, with successful titration at followup. Standardisation of the HF Medication Titration Form across Queensland has been completed, with statewide roll-out planned in 2010. doi:10.1016/j.hlc.2010.06.831

K. Muthiah ∗ , C. Hayward, P. Macdonald, E. Kotlyar, P. Spratt, E. Granger, P. Jansz, G. Kumarasinghe St. Vincent’s Hospital, Australia Background: Continuous flow left ventricular assist devices (LVADs) require combination anticoagulation and antiplatelet therapy. LVAD use has been associated with gastrointestinal tract bleeding. The purpose of this study is to determine the incidence and cause for gastrointestinal bleeding in addition to bleeding risks associated with antiplatelet/anti-thrombotic use. Methods: A retrospective analysis of 55 patients implanted with Ventrassist 3 (n = 33) and HeartWare (n = 22) referred for gastrointestinal review was performed. Eleven patients underwent endoscopy to investigate active bleeding or anaemia (9 VentrAssist, 2 HeartWare). Incidence was compared against agestandardized population rates. All patients were on warfarin, aspirin and/or clopidogrel. Results: Gastrointestinal bleeding was demonstrated in 5 patients (9% of all LVADs). Of these angiodysplasia was demonstrated in four (80%). One patient required

placement of coils to treat haemorrhage. Six further patients underwent endoscopy for investigation of iron deficiency anaemia or positive faecal occult blood. The age-standardised rate for angiodysplasia in the general population is approximately 3% of which only 20% actively bleed. Conclusion: LVAD patients have excess gastrointestinal bleeding rates. This may be due to enhanced screening, or related to intensive anti-coagulation and anti-platelet therapy. Bleeding may further be attributed to a form of acquired Von-Willebrand disease due to LVAD. Whether lack of blood pressure pulsatility contributes is unknown. It is appropriate to actively seek angiodysplasia in LVAD patients with gastrointestinal bleeding. doi:10.1016/j.hlc.2010.06.832