Abstract 16402: Role of Systemic Ocreotide in Decreasing Recurrent Lower Gastrointestinal Bleeds Related to Arteriovenous Malformation in Patients on Systemic Oral Anticoagulation
Background: Arteriovenous (AV) malformations cause significant lower gasterointestinal bleeds in patients who are on oral anticoagulation for atrial fibrillation or deep venous thrombosis. This complicates the continued care of these patients and put them at significant risk for recurrent bleeds, anemia forcing withdrawl of OAC putting the patients at risk for systemic thromboembolism. Octreotide acts as a vasoconstrictor and has a potential to minimize GI bleeds in this specific group of patients. We describe our experience in using Octreotide in patients with recurrent LGI bleeds to enable uninterrupted OAC.
Methods: This is a prospective observational study involving 25 patients who had contraindications for OAC due to LGI bleeds for AV malformations in the small and large intestine. These patients were given 100 to 300 mg of intramuscular Octreotide injection twice daily. The OAC is resumed 24-48 hours after OCT is started. We assessed the incidence of repeat GI bleeds and drop in Hb levels at 1, 3 and 6 months.
Results: There were 88% males with 75% (20/25) diagnosed with AVMs in small intestine and 25% in large intestine. All of them have been off of OAC due to multiple recurrent LGI bleeds and mean Hb of 8.3±2.3. Three patients had STE episodes and 4 patients had evidence of LAA thrombus after being off of OAC. OAC was restarted without any major bleeding in all of the patients (Apixaban in 13; Rivaroxaban in 10 patients and Warfarin in 2). All patients have been treated with Iron supplements. There was no further drop in Hb levels during the next 6 months. At follow up the mean Hb level was 11.2±2. 60% of patients subsequently underwent DCCV and were successfully placed on rhythm control with Antiarrhythmic drug therapy with the rest left in rate control. 25% of the pts were able to undergo a LAA exclusion therapy with either Lariat or Watchman. There were no STE events during the 6 months follow up.
Conclusion: IM OCT is an attractive therapeutic option in patients with severe LGI bleeds related to AVM. This enables successful reinitiation of OAC without further GI bleeds and enable further management of these patients.
Author Disclosures: D. Lakkireddy: None. M. Olayee: None. D. Atkins: None. S. Bommana: None. S. Iskandar: None. R. Afzal: None. R. Gopinathannair: Speakers Bureau; Modest; Zoll Medical, American Heart Association. Honoraria; Modest; Boston Scientific. Consultant/Advisory Board; Modest; HealthTrust PG. Research Grant; Significant; Boston Scientific. Speakers Bureau; Significant; Pfizer Inc, Bristol Myers Squibb. Consultant/Advisory Board; Significant; St. Jude Medical. L. Di Biase: None. L. Di Biase: None. L. Di Biase: None. A. Natale: None. J. Cheng: None. V. Swarup: None.
- © 2016 by American Heart Association, Inc.