Gastrointestinal
bleeding because of
arteriovenous malformations (AVMs) is an increasingly recognized complication of continuous flow left
ventricular assist devices (LVADs). Currently, therapeutic options for LVAD-associated AVMs are limited and often require repeated endoscopic procedures and reduction or cessation of anticoagulation.
Thalidomide has been utilized in the treatment of refractory
bleeding because of gastrointestinal
vascular malformations. Here we describe the case of a 66-year-old man with severe ischemic
cardiomyopathy implanted with a continuous flow HeartMate II. His postoperative course was complicated by multiple hospital admissions for gastrointestinal
bleeding because of LVAD-associated AVMs refractory to repeated
argon plasma
laser coagulation. Anticoagulation was discontinued with subsequent pump stoppage because of
thrombus requiring urgent surgical pump exchange. Following this,
thalidomide was initiated and anticoagulation with
warfarin was continued. Since initiation of
thalidomide, the patient has not had further gastrointestinal
bleeding or evidence of pump
thrombus in the subsequent 1 year.