SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients
Gastrointestinal bleeding (GIB) is common in left ventricular assist device (LVAD) patients. Serotonin release from platelets promotes platelet aggregation, and selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI) therapy inhibits the transporter responsible...
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| creator | Mawardi, George Markman, Tim M. Muslem, Rahatullah Sobhanian, Minoosh Converse, Maureen Meadows, Holly B. Uber, Walter E. Russell, Stuart D. Rouf, Rosanne Ramu, Bhavadharini Judge, Daniel P. Tedford, Ryan J. Houston, Brian A. |
| description | Gastrointestinal bleeding (GIB) is common in left ventricular assist device (LVAD) patients. Serotonin release from platelets promotes platelet aggregation, and selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI) therapy inhibits the transporter responsible for re-uptake.
We reviewed the records of LVAD (HeartMateII™, Abbott Medical, Lake Bluff, IL, USA and Heartware™, Medtronic, Minneapolis, MN, USA) patients at the Medical University of South Carolina and Johns Hopkins Hospital between January 2009 and January 2016. After exclusions, 248 patients were included for analysis. After univariate analysis, logistic regression multivariate analysis was performed to adjust for any demographic, cardiovascular, and laboratory data variables found to be associated with GI bleeding post-LVAD.
Gastrointestinal bleeding occurred in 85 patients (35%) with 55% of GIBs due to arteriovenous malformations (AVMs). Of the total cohort, 105 patients received an SSRI or SNRI during LVAD support. Forty-four (44) SSRI/SNRI (41.9%) and 41 non-SSRI/SNRI (28.7%) patients had a GIB (RR 1.46, p = 0.03). Twenty-six (26) (24.8%) of the SSRI/SNRI patients had a GIB due to AVMs versus 21 (14.7%) of the non-SSRI/SNRI patients (RR 1.69, p = 0.05). In fully-adjusted multivariate regression analysis, SSRI/SNRI therapy was independently associated with GIB (OR 1.78, p = 0.045). For GIB, the number needed to harm (NNH) was 7.6.
In conclusion, SSRI/SNRI therapy is independently associated with an increased risk of GIB in LVAD patients. |
| doi_str_mv | 10.1016/j.hlc.2019.07.011 |
| format | Article |
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We reviewed the records of LVAD (HeartMateII™, Abbott Medical, Lake Bluff, IL, USA and Heartware™, Medtronic, Minneapolis, MN, USA) patients at the Medical University of South Carolina and Johns Hopkins Hospital between January 2009 and January 2016. After exclusions, 248 patients were included for analysis. After univariate analysis, logistic regression multivariate analysis was performed to adjust for any demographic, cardiovascular, and laboratory data variables found to be associated with GI bleeding post-LVAD.
Gastrointestinal bleeding occurred in 85 patients (35%) with 55% of GIBs due to arteriovenous malformations (AVMs). Of the total cohort, 105 patients received an SSRI or SNRI during LVAD support. Forty-four (44) SSRI/SNRI (41.9%) and 41 non-SSRI/SNRI (28.7%) patients had a GIB (RR 1.46, p = 0.03). Twenty-six (26) (24.8%) of the SSRI/SNRI patients had a GIB due to AVMs versus 21 (14.7%) of the non-SSRI/SNRI patients (RR 1.69, p = 0.05). In fully-adjusted multivariate regression analysis, SSRI/SNRI therapy was independently associated with GIB (OR 1.78, p = 0.045). For GIB, the number needed to harm (NNH) was 7.6.
In conclusion, SSRI/SNRI therapy is independently associated with an increased risk of GIB in LVAD patients.</description><identifier>ISSN: 1443-9506</identifier><identifier>EISSN: 1444-2892</identifier><identifier>DOI: 10.1016/j.hlc.2019.07.011</identifier><identifier>PMID: 31635997</identifier><language>eng</language><publisher>NEW YORK: Elsevier B.V</publisher><subject>Cardiac & Cardiovascular Systems ; Cardiovascular System & Cardiology ; Female ; Gastrointestinal Hemorrhage - chemically induced ; Gastrointestinal Hemorrhage - epidemiology ; GI bleeding ; Heart Failure - therapy ; Heart-Assist Devices ; Humans ; Incidence ; Life Sciences & Biomedicine ; LVAD ; Male ; Middle Aged ; Risk Assessment - methods ; Risk Factors ; Science & Technology ; Serotonin and Noradrenaline Reuptake Inhibitors - adverse effects ; Serotonin Uptake Inhibitors - adverse effects ; SNRI ; SSRI ; United States - epidemiology</subject><ispartof>Heart, lung & circulation, 2020-08, Vol.29 (8), p.1241-1246</ispartof><rights>2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)</rights><rights>Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>13</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000570749600023</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c353t-6ffb7886db4dcb2859ec7f204b5c031ec12c39e20e06bead6d7a76c21562e5603</citedby><cites>FETCH-LOGICAL-c353t-6ffb7886db4dcb2859ec7f204b5c031ec12c39e20e06bead6d7a76c21562e5603</cites><orcidid>0000-0002-4136-7648 ; 0000-0002-3407-0248</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.hlc.2019.07.011$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,28255,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31635997$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mawardi, George</creatorcontrib><creatorcontrib>Markman, Tim M.</creatorcontrib><creatorcontrib>Muslem, Rahatullah</creatorcontrib><creatorcontrib>Sobhanian, Minoosh</creatorcontrib><creatorcontrib>Converse, Maureen</creatorcontrib><creatorcontrib>Meadows, Holly B.</creatorcontrib><creatorcontrib>Uber, Walter E.</creatorcontrib><creatorcontrib>Russell, Stuart D.</creatorcontrib><creatorcontrib>Rouf, Rosanne</creatorcontrib><creatorcontrib>Ramu, Bhavadharini</creatorcontrib><creatorcontrib>Judge, Daniel P.</creatorcontrib><creatorcontrib>Tedford, Ryan J.</creatorcontrib><creatorcontrib>Houston, Brian A.</creatorcontrib><title>SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients</title><title>Heart, lung & circulation</title><addtitle>HEART LUNG CIRC</addtitle><addtitle>Heart Lung Circ</addtitle><description>Gastrointestinal bleeding (GIB) is common in left ventricular assist device (LVAD) patients. Serotonin release from platelets promotes platelet aggregation, and selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI) therapy inhibits the transporter responsible for re-uptake.
We reviewed the records of LVAD (HeartMateII™, Abbott Medical, Lake Bluff, IL, USA and Heartware™, Medtronic, Minneapolis, MN, USA) patients at the Medical University of South Carolina and Johns Hopkins Hospital between January 2009 and January 2016. After exclusions, 248 patients were included for analysis. After univariate analysis, logistic regression multivariate analysis was performed to adjust for any demographic, cardiovascular, and laboratory data variables found to be associated with GI bleeding post-LVAD.
Gastrointestinal bleeding occurred in 85 patients (35%) with 55% of GIBs due to arteriovenous malformations (AVMs). Of the total cohort, 105 patients received an SSRI or SNRI during LVAD support. Forty-four (44) SSRI/SNRI (41.9%) and 41 non-SSRI/SNRI (28.7%) patients had a GIB (RR 1.46, p = 0.03). Twenty-six (26) (24.8%) of the SSRI/SNRI patients had a GIB due to AVMs versus 21 (14.7%) of the non-SSRI/SNRI patients (RR 1.69, p = 0.05). In fully-adjusted multivariate regression analysis, SSRI/SNRI therapy was independently associated with GIB (OR 1.78, p = 0.045). For GIB, the number needed to harm (NNH) was 7.6.
In conclusion, SSRI/SNRI therapy is independently associated with an increased risk of GIB in LVAD patients.</description><subject>Cardiac & Cardiovascular Systems</subject><subject>Cardiovascular System & Cardiology</subject><subject>Female</subject><subject>Gastrointestinal Hemorrhage - chemically induced</subject><subject>Gastrointestinal Hemorrhage - epidemiology</subject><subject>GI bleeding</subject><subject>Heart Failure - therapy</subject><subject>Heart-Assist Devices</subject><subject>Humans</subject><subject>Incidence</subject><subject>Life Sciences & Biomedicine</subject><subject>LVAD</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Science & Technology</subject><subject>Serotonin and Noradrenaline Reuptake Inhibitors - adverse effects</subject><subject>Serotonin Uptake Inhibitors - adverse effects</subject><subject>SNRI</subject><subject>SSRI</subject><subject>United States - epidemiology</subject><issn>1443-9506</issn><issn>1444-2892</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>EIF</sourceid><recordid>eNqNkE1vEzEQhq0KRL_4AVwq39Fux_auvVZPIUAbKYIqKfRovPZs4zTdjdYuVf89Lml7RJxmpHmfkd6HkA8MSgZMnq7L1caVHJguQZXA2B45YFVVFbzR_M3fXRS6BrlPDmNcAzBVCf2O7AsmRa21OiC_lsvF7HT5bTGjVysc7faRhkgnMQ4u2ISeXoe0opZehJt8posQb-nQ0XMb0ziEPmFMobcb-mmD6EN_Q0NP5z8nn-mlTQH7FI_J285uIr5_nkfkx9cvV9OLYv79fDadzAsnapEK2XWtahrp28q7lje1Rqc6DlVbOxAMHeNOaOSAIFu0XnpllXSc1ZJjLUEcEbb768YhxhE7sx3DnR0fDQPzZMusTbZlnmwZUCbbyszJjtnet3foX4kXPTnQ7AIP2A5ddLmRw9cYANQKVKVl3riYhpQ7D_10uO9TRj_-P5rTZ7s0ZkW_A47mmfBhRJeMH8I_evwB2gCamg</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Mawardi, George</creator><creator>Markman, Tim M.</creator><creator>Muslem, Rahatullah</creator><creator>Sobhanian, Minoosh</creator><creator>Converse, Maureen</creator><creator>Meadows, Holly B.</creator><creator>Uber, Walter E.</creator><creator>Russell, Stuart D.</creator><creator>Rouf, Rosanne</creator><creator>Ramu, Bhavadharini</creator><creator>Judge, Daniel P.</creator><creator>Tedford, Ryan J.</creator><creator>Houston, Brian A.</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><orcidid>https://orcid.org/0000-0002-4136-7648</orcidid><orcidid>https://orcid.org/0000-0002-3407-0248</orcidid></search><sort><creationdate>202008</creationdate><title>SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients</title><author>Mawardi, George ; Markman, Tim M. ; Muslem, Rahatullah ; Sobhanian, Minoosh ; Converse, Maureen ; Meadows, Holly B. ; Uber, Walter E. ; Russell, Stuart D. ; Rouf, Rosanne ; Ramu, Bhavadharini ; Judge, Daniel P. ; Tedford, Ryan J. ; Houston, Brian A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-6ffb7886db4dcb2859ec7f204b5c031ec12c39e20e06bead6d7a76c21562e5603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Cardiac & Cardiovascular Systems</topic><topic>Cardiovascular System & Cardiology</topic><topic>Female</topic><topic>Gastrointestinal Hemorrhage - chemically induced</topic><topic>Gastrointestinal Hemorrhage - epidemiology</topic><topic>GI bleeding</topic><topic>Heart Failure - therapy</topic><topic>Heart-Assist Devices</topic><topic>Humans</topic><topic>Incidence</topic><topic>Life Sciences & Biomedicine</topic><topic>LVAD</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Science & Technology</topic><topic>Serotonin and Noradrenaline Reuptake Inhibitors - adverse effects</topic><topic>Serotonin Uptake Inhibitors - adverse effects</topic><topic>SNRI</topic><topic>SSRI</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mawardi, George</creatorcontrib><creatorcontrib>Markman, Tim M.</creatorcontrib><creatorcontrib>Muslem, Rahatullah</creatorcontrib><creatorcontrib>Sobhanian, Minoosh</creatorcontrib><creatorcontrib>Converse, Maureen</creatorcontrib><creatorcontrib>Meadows, Holly B.</creatorcontrib><creatorcontrib>Uber, Walter E.</creatorcontrib><creatorcontrib>Russell, Stuart D.</creatorcontrib><creatorcontrib>Rouf, Rosanne</creatorcontrib><creatorcontrib>Ramu, Bhavadharini</creatorcontrib><creatorcontrib>Judge, Daniel P.</creatorcontrib><creatorcontrib>Tedford, Ryan J.</creatorcontrib><creatorcontrib>Houston, Brian A.</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Heart, lung & circulation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mawardi, George</au><au>Markman, Tim M.</au><au>Muslem, Rahatullah</au><au>Sobhanian, Minoosh</au><au>Converse, Maureen</au><au>Meadows, Holly B.</au><au>Uber, Walter E.</au><au>Russell, Stuart D.</au><au>Rouf, Rosanne</au><au>Ramu, Bhavadharini</au><au>Judge, Daniel P.</au><au>Tedford, Ryan J.</au><au>Houston, Brian A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients</atitle><jtitle>Heart, lung & circulation</jtitle><stitle>HEART LUNG CIRC</stitle><addtitle>Heart Lung Circ</addtitle><date>2020-08</date><risdate>2020</risdate><volume>29</volume><issue>8</issue><spage>1241</spage><epage>1246</epage><pages>1241-1246</pages><issn>1443-9506</issn><eissn>1444-2892</eissn><abstract>Gastrointestinal bleeding (GIB) is common in left ventricular assist device (LVAD) patients. Serotonin release from platelets promotes platelet aggregation, and selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI) therapy inhibits the transporter responsible for re-uptake.
We reviewed the records of LVAD (HeartMateII™, Abbott Medical, Lake Bluff, IL, USA and Heartware™, Medtronic, Minneapolis, MN, USA) patients at the Medical University of South Carolina and Johns Hopkins Hospital between January 2009 and January 2016. After exclusions, 248 patients were included for analysis. After univariate analysis, logistic regression multivariate analysis was performed to adjust for any demographic, cardiovascular, and laboratory data variables found to be associated with GI bleeding post-LVAD.
Gastrointestinal bleeding occurred in 85 patients (35%) with 55% of GIBs due to arteriovenous malformations (AVMs). Of the total cohort, 105 patients received an SSRI or SNRI during LVAD support. Forty-four (44) SSRI/SNRI (41.9%) and 41 non-SSRI/SNRI (28.7%) patients had a GIB (RR 1.46, p = 0.03). Twenty-six (26) (24.8%) of the SSRI/SNRI patients had a GIB due to AVMs versus 21 (14.7%) of the non-SSRI/SNRI patients (RR 1.69, p = 0.05). In fully-adjusted multivariate regression analysis, SSRI/SNRI therapy was independently associated with GIB (OR 1.78, p = 0.045). For GIB, the number needed to harm (NNH) was 7.6.
In conclusion, SSRI/SNRI therapy is independently associated with an increased risk of GIB in LVAD patients.</abstract><cop>NEW YORK</cop><pub>Elsevier B.V</pub><pmid>31635997</pmid><doi>10.1016/j.hlc.2019.07.011</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-4136-7648</orcidid><orcidid>https://orcid.org/0000-0002-3407-0248</orcidid></addata></record> |
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| subjects | Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Female Gastrointestinal Hemorrhage - chemically induced Gastrointestinal Hemorrhage - epidemiology GI bleeding Heart Failure - therapy Heart-Assist Devices Humans Incidence Life Sciences & Biomedicine LVAD Male Middle Aged Risk Assessment - methods Risk Factors Science & Technology Serotonin and Noradrenaline Reuptake Inhibitors - adverse effects Serotonin Uptake Inhibitors - adverse effects SNRI SSRI United States - epidemiology |
| title | SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients |
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