Systemic Octreotide Therapy in Prevention of Gastrointestinal Bleeds Related to Arteriovenous Malformations and Obscure Etiology in Atrial Fibrillation

Venkat Vuddanda, Mohammad Ali Jazayeri, Mohit K. Turagam, Madhav Lavu, Valay Parikh, Donita Atkins, Sudharani Bommana, Madhu Reddy Yeruva, Luigi Di Biase, Jie Cheng, Vijay Swarup, Rakesh Gopinathannair, Mojtaba Olyaee, Vijay Ivaturi, Andrea Natale, Dhanunjaya Lakkireddy

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Objectives The present study describes the use of octreotide (OCT) in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC) who have gastrointestinal (GI) bleeding related to arteriovenous malformations (AVMs), as well as its effect on OAC tolerance and subsequent rebleeding. Background AVMs cause significant GI bleeding, especially in patients with AF who are receiving OAC for stroke prevention. OCT has been shown to minimize recurrent GI bleeds related to AVMs. Methods In a multicenter, observational study, 38 AF patients with contraindications to OAC because of AVM-related GI bleeding were started on 100 μg of subcutaneous OCT twice daily. OAC was resumed in all patients within 48 h. Incidence of recurrent GI bleeds was calculated, and hemoglobin levels were recorded at enrollment and at 3 and 6 months’ follow-up. Results After a median follow-up of 8 months, 36 patients (mean age 69 ± 8.0 years; mean CHA2DS2-VASc score 3 ± 1 and mean HAS-BLED score 3 ± 1) were available for analysis. All were able to successfully resume OAC, and 28 of 36 (78%) remained on OAC at the conclusion of the study, whereas 8 underwent left atrial appendage closure with subsequent OAC discontinuation. No systemic thromboembolic events occurred in follow-up. Of the 28 patients who continued receiving OAC, 19 (68%) were free of recurrent GI bleed, 4 had minor GI bleeds, 4 required transfusion, and 1 required colectomy for GI bleeding. Mean hemoglobin levels in all patients receiving OAC were significantly higher at 3- and 6-month follow-up than at baseline (p < 0.001). Conclusions Subcutaneous OCT therapy is an attractive option in AF patients receiving OAC who have AVM-related GI bleeds. It allows successful reinitiation of OAC as a bridge to left atrial appendage exclusion or short-term relief from bleeding.

Original languageEnglish (US)
Pages (from-to)1390-1399
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume3
Issue number12
DOIs
StatePublished - Dec 11 2017
Externally publishedYes

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Keywords

  • anticoagulation
  • atrial fibrillation
  • gastrointestinal bleed
  • octreotide
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Vuddanda, V., Jazayeri, M. A., Turagam, M. K., Lavu, M., Parikh, V., Atkins, D., Bommana, S., Yeruva, M. R., Di Biase, L., Cheng, J., Swarup, V., Gopinathannair, R., Olyaee, M., Ivaturi, V., Natale, A., & Lakkireddy, D. (2017). Systemic Octreotide Therapy in Prevention of Gastrointestinal Bleeds Related to Arteriovenous Malformations and Obscure Etiology in Atrial Fibrillation. JACC: Clinical Electrophysiology, 3(12), 1390-1399. https://doi.org/10.1016/j.jacep.2017.04.022