Acute Bleeding Research Articles

S856 Clinical Predictive Factors for Endoscopic Findings in Acute Gastrointestinal Bleeding

S856 Clinical Predictive Factors for Endoscopic Findings in Acute Gastrointestinal Bleeding

S1702 Can a TEG-Based Transfusion Protocol for Acute Gastrointestinal Bleeding in Cirrhotic Patients Reduce the Utilization of Blood Products Without Elevating the Risks of Mortality and Morbidity?

S1702 Can a TEG-Based Transfusion Protocol for Acute Gastrointestinal Bleeding in Cirrhotic Patients Reduce the Utilization of Blood Products Without Elevating the Risks of Mortality and Morbidity?

Clinical and Humanistic Burden of Non-inhibitor HaemophiliaA in Five European Countries: Insights from the CHESSII Study.

HaemophiliaA (HA) is a congenital bleeding disorder caused by a deficiency/absence of factorVIII (FVIII) and characterised by frequent, acute and prolonged spontaneous or traumatic bleeding events, often leading to haemophilic arthropathy and progressive joint deterioration. HA severity is characterized by endogenous FVIII activity: mild (> 5-40%), moderate (1-5%), or severe (< 1%). HA poses a substantial clinical and socioeconomic burden on people with HA (PWHA), their caregivers, and society. This analysis evaluates clinical and patient-centric outcomes of a cohort of individuals with non-inhibitor HA sampled from France, Germany, Italy, Spain, and the UK in the 'Cost of Haemophilia in Europe: A Socioeconomic Survey II' (CHESSII) study. CHESSII was a cross-sectional burden-of-illness study collecting clinical and socioeconomic data on adult (≥ 18years) individuals with haemophiliaA or B of any severity with or without inhibitors from eight European countries. Descriptive analyses were conducted examining physician-reported demographics, clinical and health resource utilisation information. PWHA-reported health-related quality of life (HRQoL) using the EQ-5D-5L and Work Productivity and Activity Impairment (WPAI) were also examined. Outcomes were stratified by HA severity and reported at country level. Demographics and clinical characteristics of the cohort (N = 880) were generally consistent across countries. Individuals with severe HA experienced more frequent bleeding events and joint disease despite broad use of factor replacement therapy long-term prophylaxis. A minority of those with mild or moderate HA also experienced such challenges. HRQoL and workforce participation diminished, and chronic pain increased, with increasing HA severity. This analysis provides up-to-date insights on the impact of HA across five European countries. Increasing HA severity was generally associated with worse clinical outcomes, HRQoL and workforce participation. These findings suggest a place for continued evidence-based tailored treatment and clinical management approaches in addressing the residual burden of HA.

S980 Outcomes of Same Day Computed Tomography Angiography (CTA) Followed by Urgent Colonoscopy versus Urgent Colonoscopy alone for Acute Diverticular Bleeding: A Propensity Matched Cohort Study

S980 Outcomes of Same Day Computed Tomography Angiography (CTA) Followed by Urgent Colonoscopy versus Urgent Colonoscopy alone for Acute Diverticular Bleeding: A Propensity Matched Cohort Study

Outcome of Negative Computed Tomographic Angiography in the Management of Gastrointestinal Bleeding at a Tertiary Centre: A Cross-sectional Study

INTRODUCTION: Acute gastrointestinal bleeding is a common gastrointestinal emergency. Only limited studies are available regarding the clinical outcomes after computed tomographic angiography (CTA) mesentery showed negative for active bleed. This study aims to determine the clinical outcome of negative mesentery CTA in patients with clinically active acute gastrointestinal (GI) bleeding. MATERIAL AND METHODS: A cross-sectional study with a universal sampling method was used. Patients who underwent CTA to detect gastrointestinal bleeding in the National University Hospital of Malaysia from December 2015 until March 2021 were retrospectively analysed. The outcome of each patient, risk of re-bleeding, and 30-days mortality rate were evaluated and assessed. RESULTS: In total, 280 CTAs were performed on 232 patients, with 186 of them showing negative results on their first initial CTA. 40.8% (76/186) of those with negative initial CTA had recurrent bleeding and 73.6% (56/76) of them required active intervention. We found that the risk of re-bleeding is lower in the upper gastrointestinal group compared to the lower gastrointestinal group (OR=1.5, 95% CI: 0.877- 2.852, p: 0.128). The overall 30 days mortality rate after the first negative CTA was 23.1% (43/186). Among those patients who experienced re-bleeding, 32.8% (25/76) died within 30 days, with 18.4% (14/76) succumbing to massive bleeding. CONCLUSION: From our analysis, it can be concluded that a clinically active GI bleeding with negative mesentery CTA has a 40.8% chance to re-bleed with 23.1% 30-day mortality rate. Close observation and follow-up

S843 Social Determinants of Therapeutic Endoscopy and Procedure Time in Patients With Acute Upper Gastrointestinal Bleeding

S843 Social Determinants of Therapeutic Endoscopy and Procedure Time in Patients With Acute Upper Gastrointestinal Bleeding

S3631 A Case of Acute Gastrointestinal Bleeding Secondary to Acquired Hemophilia A

S3631 A Case of Acute Gastrointestinal Bleeding Secondary to Acquired Hemophilia A

S973 Acute Gastrointestinal Bleed in Bariatric Surgery Patients: A Nationwide Population Based Study

S973 Acute Gastrointestinal Bleed in Bariatric Surgery Patients: A Nationwide Population Based Study

S955 Dual Antiplatelet Therapy Management During Acute Gastrointestinal Bleeding After Percutaneous Coronary Intervention: A Real-World Nationwide Analysis

S955 Dual Antiplatelet Therapy Management During Acute Gastrointestinal Bleeding After Percutaneous Coronary Intervention: A Real-World Nationwide Analysis

Real-world evaluation of Brainomix e-Stroke software

Background and purposeBrainomix e-Stroke is an artificial intelligence-based decision support tool that aids the interpretation of CT imaging in the context of acute stroke. While e-Stroke has the potential to...

On the Frontlines of Pre-Hospital Care: The Efficacy of Freeze-Dried Plasma

Despite continued developments made in the field of trauma care, hemorrhagic shock resulting from trauma remains the leading cause of preventable death on the battlefield. The current methods being used for the treatment of patients with acute hemorrhage include dressing the wound in an attempt to stop the bleeding, along with intravenous administration of fluids intended to replace the blood loss and treat the accompanying shock. The question of what kind of fluid to use is one that fascinated many throughout history, consequentially leading to the development of physiological crystalloid based solutions on one hand and isolated blood products on the other. With its introduction, plasma was found to have significant clinical benefits, conceivably because plasma replenishes various coagulation proteins that are consumed during the coagulopathy that often accompanies traumatic injuries. In military and remote settings, the logistical limitations of plasma, namely the need to maintain a comprehensive cold-chain infrastructure and the complicated process of thawing the plasma, restricted the use of plasma in these settings. In World War II, these barriers were lifted as Freeze-Dried Plasma (FDP) was invented, not requiring any freezers and soon available. This product was vastly used during the war with hundreds of thousands treated, but then disremembered because of disease transmission issues such as hepatitis found among recipients in the 1960’s. Modern-day advanced techniques have improved the safety and made it possible to produce safe and effective dried plasma solving the previous problems, but still, FDP is currently used by only a few countries worldwide. In line with its unpopularity, little has been published regarding the clinical effects of this product. Purpose of this Study: To shed light on the clinical effectiveness of using freeze-dried plasma as a pre-hospital resuscitation fluid during the treatment of hemorrhagic shock in the pre-hospital setting. Methods: A retrospective analysis of data collected on trauma patients injured in the Syrian civil war and treated by the IDF from 2014 until 2016. Casualties who required long evacuation time (i.e., over 45 minutes) were chosen. Two groups of casualties were allocated according to weather FDP was used (N=29), or standard-care fluids were given (N=83). Results: Using FDP as part of the pre-hospital resuscitation was shown to be associated with an improvement in both vital signs and shock index score. Moreover, among these patients, a lower transfusion volume was needed throughout their hospitalization. However, an increased risk for mortality, increased risk of in-hospital blood transfusion, and increased risk of pre-hospital intubation were observed in the FDP treated group. Conclusions: The effectiveness of FDP presented inconclusive but promising results in lowering the severity of shock and reducing iatrogenic coagulopathy in trauma patients. Further research is needed to disprove the adverse outcomes of this study.

Time of Brain Imaging In Patients With An Acute Traumatic Intracranial Haemorrhage

Abstract Background We observed variation in timing of CT brain imaging in patients presenting with a history of trauma. The objective of this audit was to determine adherence to local ED CT Head Criteria in patients with a confirmed traumatic ICH. Methods Retrospective point prevalence audit of patients with a confirmed intracranial haemorrhage over a five-month period using our neurotrauma work-stream data. Exploration of CT timing between Criteria A (within 60 minutes) and Criteria B (within 8 hours). Characteristics reviewed included Gender, Age, Time of presentation to ED, Day of Arrival, GCS on presentation, Mechanism of Injury and Time of CT completion. Results 68 patients over the five-month period had a confirmed ICH: 48 male, 20 female. The median age was 62 years (range 17-97). Falls of less than 2 metres were the most frequent cause of injury (n=44, 65%), with 60% of these occurring in patients aged over 65 years of age. 67% (n=31) of patients meeting Criteria A did not have a CT Brain completed within 60 minutes. 14% (n=3) of patients meeting Criteria B did not have a CT Brain completed within 8 hours. Of patients meeting criteria who did not have a timely CT, 11 patients presented out of hours. Patients aged less than 65 years of age were less likely to meet target CT timing; 71% (n=24). Conclusion This audit highlights that only 33% of patients meeting Criteria A had brain imaging within one hour. Older adults were more likely to meet target CT timing than younger adults. Lack of ED access to radiology out of hours was deemed to be the main barrier to meeting target CT timing. We are working alongside our radiology department to secure no discussion trauma CT scans in ED out of hours. We plan to re-audit following the implementation of this change.

Retracted: A Pre-Hospital Prediction Tool for Stroke Type Utilising Machine Learning Techniques

Abstract Background Stroke is a leading cause of death worldwide and leaves most survivors with permanent disability. 12.2 million people suffer strokes annually, of which 70% occur in low- and middle-income countries (LMIC). Stroke presents diagnostic challenges which limits access to effective, but time-sensitive, reperfusion therapies. Currently, stroke is diagnosed by the combination of clinical symptoms and signs and brain imaging. The aim of this study was to develop clinical prediction tools, for differentiating acute ischemic stroke (AIS) and intracerebral haemorrhage (ICH) in the pre-hospital setting without neuroimaging, utilising machine learning (ML). Methods We included 5349 patients with confirmed acute stroke who presented within 6 hours of symptom onset, from the INTERSTROKE case-control study. We compared predictions using six commonly used ML algorithms for classification i.e. multivariate logistic regression (MLR), k-nearest neighbour (KNN), support vector machine (SVM), neural networks (NN), random forests (RF), XGBoost. Algorithm inputs included medical history, symptoms and signs, and point-of-care blood tests, with an output of final diagnosis. Results The training cohort included 4280 patients with 3084 ischemic stroke and 1196 ICH cases, and the test cohort included 1069 patients with 771 ischemic stroke and 298 ICH cases. From 174 potential variables, we used univariate analyses to select 52 candidate variables for inclusion in the ML algorithms. These were selected based on their ability to predict (p &amp;lt; 0.20) stroke subtype. The AUCs in the test cohort for each of the ML classification models were: MLR 0.819, KNN 0.795, SVM 0.802, NN 0.814, RF 0.814, and XGBoost 0.807. Conclusion ML models showed great potential to predict stroke type at the prehospital stage and have comparable predictive abilities to previously developed ML prediction tools. This may facilitate point-of-care decisions and management of stroke in the pre-hospital setting in the future.

Terlipressin-induced skin necrosis in cirrhotic patients-A case report and comprehensive literature review.

The occurrence of terlipressin-induced skin necrosis in cirrhotic patients is a rare but serious adverse event that warrants further investigation. Clinicians should be aware of this potential complication in cirrhotic patients receiving terlipressin therapy and closely monitor for any signs of skin necrosis. Early recognition and prompt intervention are crucial in preventing further complications and improving patient outcomes. Further research is needed to better understand the risk factors associated with terlipressin-induced skin necrosis and to develop effective preventive strategies. Overall, healthcare providers should exercise caution when prescribing terlipressin to cirrhotic patients, weighing the potential benefits against the risks of this rare but significant adverse event. Terlipressin is commonly used to manage conditions related to portal hypertension, such as hepatorenal syndrome and esophageal variceal bleeding. Despite its therapeutic benefits, terlipressin can rarely lead to severe ischemic complications involving the skin vasculature, known as terlipressin-induced skin necrosis. We present a 50-year-old male with cirrhosis and acute variceal bleeding who developed skin necrosis following terlipressin administration. We performed a comprehensive review of the literature by analyzing 18 case reports/case series comprising 22 cirrhotic patients with terlipressin-induced skin necrosis. Among these individuals, we found a mean age of 51 years with a male predominance (78%). Further analysis showed that the onset of skin necrosis ranged from 2 to 5 days post-terlipressin initiation, with bolus administration being predominant (85.7%). The underlying pathophysiological mechanisms of terlipressin-induced skin ischemia are still elusive but primarily attributed to the vasoconstrictive and thrombogenic effects. Management involves terlipressin discontinuation and supportive care. Physicians should be aware of this potential complication in patients receiving terlipressin and closely observe for any signs of skin rash.

Assessment of large-scale imaging practices in patients with acute brain hemorrhage in French emergency departments: Emergency imaging practices in hemorrhagic stroke

ObjectiveIntracerebral hemorrhage (ICH) is a life-threatening condition, where imaging plays a crucial role but remains poorly standardized. Our main objective was to analyze the imaging protocols used during the acute phase of ICH and ascertain the proportion of patients diagnosed with secondary hemorrhage. Patients and methodsA multicenter retrospective observational study was conducted across over 100 French hospitals affiliated with a national tele-imaging network dedicated to emergency imaging. Among patients managed in the “Stroke Alert” pathway for suspected acute stroke from March 2021 to April 2023, those with ICH diagnosed within 24 h of symptoms onset were identified. Their imaging reports were reviewed to identify the imaging modality used and protocols performed and investigate whether a secondary cause was identified. ResultsOf the 18,356 patients included in the ”Stroke Alert” pathway, 662 cerebral hemorrhages were identified (3.6 %). Computed tomography (CT) was the most widely used imaging modality in the acute phase (71.8 % of examinations). Vascular imaging was performed in 78 % of patients with cerebral hemorrhage, most often CT angiography or TOF magnetic resonance angiography. A secondary cause was identified in 8.2 % (54/662) of cerebral hemorrhages, including vascular imaging in the vast majority of cases (92.6 %). ConclusionOptimization and standardization of imaging protocols in the acute phase of ICH is essential to improve the detection of its secondary causes, particularly vascular, requiring urgent treatment. Vascular imaging improves their early detection.

Trial Of Pathogen-reduced Cryoprecipitate vs. Cryoprecipitated AHF to Lower Operative Transfusions (TOP-CLOT): study protocol for a single center, prospective, cluster randomized trial

BackgroundIntraoperative hemorrhage in cardiac surgery increases risk of morbidity and mortality. Low pre-operative and perioperative levels of fibrinogen, a key clotting factor, are associated with severity of hemorrhage and increased transfusion of blood components. The ability to supplement fibrinogen during hemorrhagic resuscitation is delayed 45–60 min because cryoprecipitated antihemophilic factor (cryo AHF) is stored frozen, due to a short post-thaw shelf life. Pathogen Reduced Cryoprecipitated Fibrinogen Complex (INTERCEPT Fibrinogen Complex, IFC) can be kept thawed, at room temperature, for up to 5 days, making it possible to be immediately available for hemorrhaging patients. This trial will investigate if earlier correction of acquired hypofibrinogenemia with IFC in hemorrhaging cardiac surgery patients reduces the total number of perioperatively transfused allogeneic blood products (red blood cells, plasma, and platelets) as compared to cryo AHF.MethodsThis is a single center, prospective, cluster randomized trial with an adaptive design. Acquired hypofibrinogenemia will be assessed by rotational thromboelastometry (ROTEM) and the threshold for cryo AHF/IFC transfusion defined as FIBTEM A10 ≤ 10 mm in bleeding patients. IFC/cryo AHF will be randomized by 1-month blocks. Cardiac surgery patients will be enrolled in the study if they have an eligible procedure and at least one dose of a cryo AHF/IFC product (approximately 2 g fibrinogen) is transfused. Data from the electronic health record, including the blood bank and lab information systems, will be prospectively collected from the health system’s data warehouse.DiscussionThis trial aims to provide evidence of the clinical efficacy of utilizing readily available thawed IFC during acute bleeding in the cardiac surgery setting compared to traditional cryo AHF.Trial registrationClinicalTrials.gov NCT05711524. Feb 3, 2023.

Transjugular intrahepatic portosystemic shunt for esophagogastric variceal bleeding in patients with hepatocellular carcinoma and portal vein tumor thrombus.

Whether hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) and acute esophagogastric variceal bleeding (EGVB) can improve the success rate of endoscopic hemostasis and overall survival (OS) from transjugular intrahepatic portosystemic shunt (TIPS) remains controversial. To compare the clinical outcomes between TIPS and standard treatment for such HCC patients. This monocenter, retrospective cohort study included patients diagnosed as HCC with PVTT and upper gastrointestinal bleeding. Patients were grouped by the treatment (TIPS or standard conservative treatment). The success rate of endoscopic hemostasis, OS, rebleeding rates, and main causes of death were analyzed. Between July 2015 and September 2021, a total of 77 patients (29 with TIPS and 48 with standard treatment) were included. The success rate of endoscopic hemostasis was 96.6% in the TIPS group and 95.8% in the standard treatment group. All the 29 patients in TIPS group successful underwent TIPS procedure and had a better OS compared with standard treatment within the first 160 days after treatment (68 days vs 43 days, P = 0.022), but shorter OS after 160 days (298 days vs 472 days, P = 0.022). Cheng's Classification of PVTT, total bilirubin and Child-Pugh class were independently negative associated with OS (all P < 0.05). The main causes of death were liver failure or hepatic encephalopathy (75.9%) in the TIPS group and rebleeding (68.8%) in the standard treatment. TIPS could reduce the risk of early death due to rebleeding and prolong short-term survival in HCC patients with PVTT and acute EGVB, which deserves further investigation.

An Artificial Intelligence Algorithm Integrated into the Clinical Workflow Can Ensure High Quality Acute Intracranial Hemorrhage CT Diagnostic.

Intracranial hemorrhage (ICH) is alife-threatening condition requiring rapid diagnostic and therapeutic action. This study evaluates whether Artificial intelligence (AI) can provide high-quality ICH diagnostics and turnaround times suitable for routine radiological practice. Aconvolutional neural network (CNN) was trained and validated to detect ICHs on DICOM images of cranial CT (CCT) scans, utilizing about 674,000 individually labeled slices. The CNN was then incorporated into acommercial AI engine and seamlessly integrated into three pilot centers in Germany. Areal-world test-dataset was extracted and manually annotated by two experienced experts. The performance of the AI algorithm against the two raters was assessed and compared to the inter-rater agreement. The overall time ranging from data acquisition to the delivery of the AI results was analyzed. Out of 6284 CCT examinations acquired in three different centers, 947 (15%) had ICH. Breakdowns of hemorrhage types included 8% intraparenchymal, 3% intraventricular, 6% subarachnoidal, 7% subdural, < 1% epidural hematomas. Comparing the AI's performance on asubset of 255 patients with two expert raters, it achieved asensitivity of 0.90, aspecificity of 0.96, an accuracy of 0.96. The corresponding inter-rater agreement was 0.84, 0.98, and 0.96. The overall median processing times for the three centers were 9, 11, and 12 min, respectively. We showed that an AI algorithm for the automatic detection of ICHs can be seamlessly integrated into clinical workflows with minimal turnaround time. The accuracy was on par with radiology experts, making the system suitable for routine clinical use.

Epidemiology and Functional Outcome of Acute Stroke Patients in Korea using Nationwide data.

Korea's healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. 86,568 acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016 to 2021, focusing on acute subarachnoid hemorrhage, acute intracerebral hemorrhage, and acute ischemic stroke. Of these 86,568 patients, 8.3% was subarachnoid hemorrhage, 16.3% intracerebral hemorrhage, and 74.9% ischemic stroke. Trends showed decreasing subarachnoid hemorrhage and increasing intracerebral hemorrhage cases over the years. 68.3% stroke patients had the clear onset time. 49.6 % stroke patients arrived within 4.5 hours of symptom onset, with more treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of subarachnoid hemorrhage patients, 34.6% of intracerebral hemorrhage patients, and 63.8% of ischemic stroke patients. The results showed that ischemic stroke was the most common subtype, followed by intracerebral hemorrhage and subarachnoid hemorrhage. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and subarachnoid hemorrhage compared to intracerebral hemorrhage.

Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Treatment of Bleeding from Cardiofundal and Ectopic Varices in Cirrhosis

Acute variceal bleeding in cirrhosis represents a critical clinical event that significantly impacts patient prognosis, with mortality rates increasing further after a second episode. This underscores the need for immediate intervention and optimal prophylaxis. The creation of a transjugular intrahepatic portosystemic shunt (TIPS) has been proven to be highly effective for managing esophageal variceal bleeding. However, the use of TIPS for managing cardiofundal gastric varices and ectopic varices remains debated due to their unique vascular anatomy and the limited data available. These varices, although less prevalent than esophageal varices, are complex and heterogeneous vascular shunts between the splanchnic venous system and the systemic veins. Indeed, while endoscopic therapy with tissue adhesives is widely endorsed for achieving hemostasis in active hemorrhage, there is no consensus regarding the optimal approach for secondary prophylaxis. Recent research emphasizes the efficacy of endovascular techniques over endoscopic treatments, such as TIPS and endovascular variceal embolization techniques. This review examines the use of TIPS in managing acute variceal bleeding in patients with cirrhosis, focusing specifically on cardiofundal gastric varices and ectopic varices, discussing optimal patient care based on the latest evidence, aiming to improve outcomes for this challenging subset of patients.