How does octreotide stop bleeding

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They found no reduction in mortality with octreotide. They found the treatment group did have, on average, 0. The other ED use for octreotide is in sulfonylurea overdose with hypoglycemia. Patients who present with sulfonylurea-induced hypoglycemia may initially respond to treatment with IV dextrose.

However, the increase in blood sugar can then trigger insulin release, and cause worse rebound hypoglycemia from the increased insulin along with continued activity of the sulfonylurea, which both stimulates insulin release and also increases peripheral sensitivity to insulin.

Octreotide inhibits the secretion of insulin, and can help prevent this recurrent hypoglycemia [7]. Notable History Octreotide was first synthesized in Early studies touted its property as an antagonist of the opiate mu receptors [9].

It is currently not used in this manner, but has been used to treat diarrheal symptoms in patients withdrawing from opiates because of its anti-motility properties, as part of a multi-component rapid antagonist induction [10]. Three weeks later, she was admitted with suction alarms from the HeartWare and was found to have Hb of 6.

Repeat EGD and capsule endoscopy were negative. By this time, she had received 30 units of packed red blood cells. Over a period of three days, her Hb remained stable at 8. Octreotide therapy was then held due to its lack of evidence in this setting and a theoretical increased risk of platelet activation. The following day, hemoglobin trended down to 7. Another blood transfusion was given, bringing her Hb back up to 9.

Her Hb remained stable at 9. She did not require any transfusions for 3 weeks, following which she was once again admitted with low Hb and needed further transfusions. Repeat EGD was performed and showed one actively oozing erosion in the body of the stomach, two nonbleeding arteriovenous malformations in the distal duodenum, and two actively oozing arteriovenous malformations in the proximal jejunum all of which were ablated. Her Hb stabilized prior to discharge. Left ventricular assist devices LVADs are frequently used for the management of advanced heart failure patients [ 1 ].

Continuous flow LVADs are preferred over the pulsatile flow LVADs due to smaller size and less surgical trauma; however, they pose an increased risk for gastrointestinal GI bleeding [ 2 ]. Several theories have been proposed as the possible mechanism of bleeding in these patients, including reduced arterial pressure leading to GI arteriovenous malformations, development of Von Willebrand syndrome, and mucosal ischemia [ 3 ].

She required weekly blood transfusions despite multiple GI investigations, stopping antiplatelet medications and lowering her INR goal, and efforts to maintain pulsatility by reducing her LVAD speed.

However, her Hb finally stabilized after starting octreotide therapy. Prior studies have shown that the use of long acting somatostatin analogues in patients with angiodysplasia has reduced the frequency of recurrent bleeding and need for further transfusion, though not completely eliminating it [ 4 ]. In , Rennyson et al. He responded with decreased frequency of GI bleeding and reduced need for subsequent transfusions [ 5 ].

In , Coutance et al. In , a small single institution study demonstrated that using octreotide for management of GI bleeding in patients with LVADs did not result in any significant difference in the length of stay, units of packed red blood cells administered, rebleeding episodes, or mortality [ 7 ].

The above data suggests that octreotide may be a viable option for LVAD patients with recurrent episodes of GI bleeding. This therapy is especially attractive for BTT patients in whom recurrent blood transfusions are avoided due to possible sensitization. However, further studies are required to validate these findings in larger patient population and comparison of its use in pulsatile versus continuous flow devices before this can become a standard of care in such patients.

The authors declare that there is no conflict of interests regarding the publication of this paper. Geetanjali Dang, Ryan Grayburn, and Nunzio Gaglianello were responsible for drafting the paper and the content. Geoffrey Lamb and Adrian Umpierrez De Reguero were responsible for critical revision of the paper for important intellectual content.