Association between Digoxin Use and Gastrointestinal Bleeding in Contemporary Continuous Flow Left Ventricular Assist Device Support

Purpose Digoxin use has been associated with reduced rate of gastrointestinal bleeding (GIB) in a previous study of patients on left ventricular assistive device (LVAD) support. The purpose of this study was to test the association between digoxin use and GIB events in a large, multicenter, contemporary dataset inclusive of HeartMate 3 devices. Methods Patients with complete data on GIB events and digoxin use from two medical centers were included in the analysis (total n=650). GI bleeding events were captured out to 2 years of follow up and digoxin use was defined as digoxin prescribed at discharge or within the first 3 months after LVAD implantation. A negative binomial regression model was performed to determine association between digoxin use and number of GI bleeding events over 2 years of LVAD support. Results Mean age of the study cohort was 57 years (±14), 45 % were bridge to transplant (BTT), and 78% had HeartMate 2 devices. Thirteen % received HeartMate 3 devices. Digoxin was prescribed in 31% of patients. Patients on digoxin had better renal function at the time of LVAD implantation (1.19 vs 1.21, P= 0.037), lower INTERMACS profile (INTERMACS 2-3: 56 % vs. 48 %, P Conclusion In this large multicenter study, inclusive of the most contemporary devices, digoxin use was associated with reduced GI bleeding events. Prospective data will be required to confirm this hypothesis.