Abstract

Gastrointestinal bleeding due to arteriovenous malformations (AVM) is an increasingly recognized complication of continuous flow left ventricular assist devices (LVAD). Currently, therapeutic options for LVAD-associated AVMs are limited and often require repeated endoscopic procedures and reduction or cessation of anticoagulation. Thalidomide has been utilized in the treatment of refractory bleeding due to gastrointestinal vascular malformations. Here we describe the case of a 66-year-old patient with severe ischemic cardiomyopathy implanted with a continuous flow Heartmate II. His post-operative course was complicated by multiple hospital admissions for gastrointestinal bleeding due to LVAD-associated AVMs refractory to repeated argon plasma laser coagulation (APC). Anticoagulation was discontinued with subsequent pump stoppage due to thrombus requiring urgent surgical pump exchange. Following this, thalidomide was initiated and anticoagulation with warfarin was continued. Since initiation of thalidomide, the patient has not had further gastrointestinal bleeding or evidence of pump thrombus in the subsequent 1 year.

View details for DOI 10.1097/MAT.0000000000000087

View details for PubMedID 24830804