Abstract 21207: Use of Digoxin, an Inhibitor of Hypoxia Inducible Factor 1A Synthesis, is Associated With Decreased Incidence of Gastrointestinal and Arteriovenous Malformations Related Bleeding in Patients With Continuous-Flow Left Ventricular Assist Device

Introduction: Gastrointestinal bleeding (GIB) occurs in 20-40% of patients with continuous flow left ventricular assist device (CF-LVAD) during the first years of follow up and is most commonly due to arteriovenous malformations (AVM). Although the precise pathophysiology of AVM formation during CF-LVAD support has not been established, it is postulated that hypoperfusion in the splanchnic vascular territory and resultant hypoxia may activate the angiogenesis signaling cascade via the HIF1α/angiopoietin-2 pathway. Interestingly, digoxin is a potent inhibitor of HIF1α synthesis. Hypothesis: We hypothesize that digoxin therapy can be associated with a decrease incidence of GI and AVM bleeding in CF-LVADs patients. Methods: Charts of all adult patients implanted with CF-LVAD between February 2006 and February 2017 were reviewed with emphasis on occurrence and etiology of GIB. Kaplan Meier (KM) and logistic regression analysis were used to assess the frequency of overall GI and AVM bleeding and their association with digoxin therapy. Results: Sixty-two of 204 patients (30%) experienced a GIB and 20 of 62 (32%) bleeds were due to AVM. Both overall frequency of GIB (18% vs 37% of patients, p Conclusions: Use of digoxin was associated with a significant reduction in overall GIB as well as AVM bleeding. Prospective studies are needed to validate this finding and its mechanistic underpinnings.