Gastrointestinal (GI) bleeding is a leading cause of readmission following left ventricular assist device (LVAD) implantation. The pathophysiology of GI bleeding in this population is multifactorial but is highly associated with the formation of arteriovenous malformations, and exacerbated by acquired von Willebrand disease. High-risk populations have been identified, and risk mitigation strategies can be employed in these patients. Management of GI bleeding includes the use of endoscopy and colonoscopy to identify and treat lesions. As much of the bleeding originates in the small intestine, adjunct tests including capsule endoscopy or push enteroscopy are often required. Refractory cases may require concomitant use of medications such as thalidomide or bevacizumab. Several therapies have been identified for both primary and secondary prevention of bleeding. Ongoing studies are identifying the impact of reduced antiplatelet and anticoagulation protocols on GI bleeding rates.