@Article{duepublico_mods_00081887,
  author = 	{Jakstaite, Aiste-Monika
		and Luedike, Peter
		and Schmack, Bastian
		and Pizanis, Nikolaus
		and Riebisch, Matthias
		and Weymann, Alexander
		and Kamler, Markus
		and Ruhparwar, Arjang
		and Rassaf, Tienush
		and Papathanasiou, Maria},
  title = 	{Increased bleeding risk with phosphodiesterase-5 inhibitors after left ventricular assist device implantation},
  year = 	{2021},
  month = 	{Apr},
  day = 	{05},
  keywords = 	{Left ventricular assist devices; Sildenafil; Tadalafil; Phosphodiesterase-5 inhibitors},
  abstract = 	{Aims: Therapy with phosphodiesterase-5 inhibitors (PDE5Is) after left ventricular assist device (LVAD) implantation has been associated with lower mortality and device thrombosis but increased risk for post-operative and gastrointestinal bleeding. We aimed to evaluate the impact of long-term PDE5Is on the overall bleeding risk after LVAD implantation. Methods and results: We retrospectively included patients who received a continuous-flow LVAD at our site and were prescribed with long-term oral PDE5Is after discharge from the index hospitalization. The primary endpoint was the occurrence of bleeding at 12 month follow-up. Secondary endpoints were all-cause death and the combination of bleeding and all-cause death. Our analysis included 109 patients of whom 75 (69{\%}) received long-term PDE5Is. Mean age was 56 years, and 85{\%} were male. At 12 months, 19 (17{\%}) patients experienced at least one bleeding event. Patients on PDE5Is had higher bleeding rates (23{\%} vs. 6{\%}, P = 0.03) and more bleeding events per patient-year (0.32 vs. 0.06, P = 0.03) compared with patients not on PDE5Is. While overall bleeding incidence was excessively higher in the PDE5I group, there were no significant differences in the incidence of major bleeding (19{\%} vs. 6{\%}, P = 0.08) and gastrointestinal bleeding (11{\%} vs. 3{\%}, P = 0.18). Kaplan--Meier analysis revealed higher cumulative incidence of bleeding for the PDE5I group (log rank = 0.04) with no difference on all-cause death (log rank = 0.67) and the combination of bleeding and all-cause death (log rank = 0.13). Hospitalizations for bleeding and their duration were numerically higher in the PDE5I group (0.28 vs. 0.03, P = 0.07 and 2.4 vs. 0.2, P = 0.07, respectively). Conclusions: Phosphodiesterase-5 inhibitor treatment after LVAD implantation is associated with increased bleeding risk after LVAD implantation. The safety of long-term PDE5Is in LVAD patients remains unclear and needs to be further clarified in prospective studies with randomized study design.},
  note = 	{<p>The publication of this article was supported by the Publication Fund of the University of Duisburg-Essen.</p>

<p>Open access funding enabled and organized by Projekt DEAL.</p>

<p>This work was supported by the Universit{\"a}tsmedizin Essen Clinician Scientist Academy (UMEA) and the German Research Foundation [Deutsche Forschungsgemeinschaft (DFG)] (FU356/12-1 to M.P., LU2139/2-1 to P.L., and RA969/12-1 to T.R.).</p>},
  note = 	{<p>Jakstaite, A.-M., Luedike, P., Schmack, B., Pizanis, N., Riebisch, M., Weymann, A., Kamler, M., Ruhparwar, A., Rassaf, T., and Papathanasiou, M. (2021) Increased bleeding risk with phosphodiesterase-5 inhibitors after left ventricular assist device implantation. <em>ESC Heart Failure</em>, 8: 2419--2427. <a href="https://doi.org/10.1002/ehf2.13322">https://doi.org/10.1002/ehf2.13322</a>.</p>

<p>First published: 05 April 2021</p>},
  note = 	{Version of Record / Verlagsversion},
  doi = 	{10.1002/ehf2.13322},
  url = 	{https://duepublico2.uni-due.de/receive/duepublico_mods_00081887},
  url = 	{https://doi.org/10.1002/ehf2.13322},
  file = 	{:https://duepublico2.uni-due.de/servlets/MCRFileNodeServlet/duepublico_derivate_00081901/ESC_Heart_Failure_2021_8_2419-2427.pdf:PDF},
  language = 	{en}
}