Elsevier

JACC: Clinical Electrophysiology

Volume 3, Issue 12, 11 December 2017, Pages 1390-1399
JACC: Clinical Electrophysiology

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

https://doi.org/10.1016/j.jacep.2017.04.022Get rights and content
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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.

Key Words

anticoagulation
atrial fibrillation
gastrointestinal bleed
octreotide
stroke

Abbreviations and Acronyms

AF
atrial fibrillation
AVM
arteriovenous malformation
CF-LVAD
continuous-flow left ventricular assist device
GI
gastrointestinal
LAAC
left atrial appendage closure
OAC
oral anticoagulation
OCT
octreotide

Cited by (0)

Dr. Di Biase is a consultant to Stereotaxis, Biosense Webster, and St. Jude Medical; and has received speaker honoraria/travel reimbursement from Biotronik, Medtronic, Boston Scientific, Janssen, Pfizer, and Epi EP. Dr. Swarup has served as a consultant to Abbot Vascular and Biosense Webster; and is on the speakers bureaus for St. Jude Medical, Boston Scientific, Janssen, and Pfizer. Dr. Gopinathannair has served as a consultant to St. Jude Medical and Boston Scientific; has served on the speakers bureau for the American Heart Association, Pfizer, Bristol-Myers Squibb, Zoll Medical, and AltaThera Pharmaceuticals; and has served on an advisory board for HealthTrust PG. Dr. Natale is a consultant for Stereotaxis, Biosense Webster, and St. Jude Medical; and has received speaker honoraria/travel reimbursements from Biotronik, Medtronic, Boston Scientific, Janssen, Pfizer, and Epi EP. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.