Gastrointestinal Bleeding Research Articles

Use of Aspirin and Initial Cardiovascular and Bleeding Risk in Patients with Chronic Kidney Disease

Background: Despite the high cardiovascular risk in patients with chronic kidney disease (CKD), the role of aspirin in primary prevention remains unclear. This study aimed to investigate the association between aspirin initiation in adults with CKD without prior cardiovascular disease (CVD) and the first cardiovascular and bleeding events using Korean nationwide cohort data. Methods: Among individuals aged 40–79 years with an estimated glomerular filtration rate between 15 and 59 mL/min/1.73 m2 who underwent routine health examinations between 2011 and 2016, 15,861 individuals who were newly prescribed aspirin at a dose of 100 mg/day were matched with 79,305 aspirin non-users by propensity score matching. The primary efficacy outcome was a composite of nonfatal atherosclerotic CVD or cardiovascular death. The primary safety outcome was hospitalization due to intracranial or gastrointestinal bleeding. Results: During a mean follow-up of 6.9±2.9 years, the incidence rates for the primary efficacy outcome in aspirin users and non-users were 8.0 and 9.0 per 1,000 person-years, respectively. Aspirin therapy initiation was not associated with the primary efficacy outcome (hazard ratio [HR], 0.93; 95% confidence intervals [CI], 0.86-1.04). However, the primary safety outcome of major bleeding was more frequent in aspirin users than in non-users (6.7 versus 4.7 per 1,000 person-years). The HR for this outcome in aspirin users versus non-users was 1.45 (95% CI, 1.32-1.59). Conclusions: No association was observed between aspirin use and the risk of nonfatal atherosclerotic CVD or cardiovascular death in patients with CKD stages G3 and G4 without prior CVD. Aspirin use was associated with higher risk of major bleeding.

Urgent Reversal of Direct Oral Anticoagulants in Critical and Life-Threatening Bleeding: A Multidisciplinary Expert Consensus

Direct oral anticoagulants (DOACs) are increasingly being used due to their improved efficacy/safety ratio and lower clinical and economic burden when compared to vitamin K antagonists. However, bleeding is still the most frequent complication associated with DOACs, and although rare, bleeding episodes can be life-threatening or critical. The impact of DOAC anticoagulation activity during a bleeding event must be evaluated according to patient clinical assessment, dosage and time from last intake, the presence of comorbidities (especially kidney and liver dysfunction), and, whenever possible, coagulation tests. Unfortunately, DOACs’ anticoagulation activity is not easily or usually detectable in routine common coagulation testing. Specific DOAC tests allow for specific drug monitoring, but they are too time consuming, and are usually unavailable in routine emergency practice. If a clinically relevant DOAC plasma concentration is assumed or proven in a severe bleeding scenario, DOAC reversal is needed to restore hemostasis. This experts’ consensus provides a narrative review about DOAC reversal and practical life-threatening bleeding management in several scenarios (trauma, intracranial hemorrhage and gastrointestinal bleeding), focusing on the selection of patients to whom specific reversal agents should be given.

Endovascular treatment of postoperative gastrointestinal bleeding

Objective. To analyze the results of endovascular treatment of postoperative gastrointestinal bleeding. Materials and methods. During the period 2014–2024, 328 endovascular interventions were performed in 297 patients with postoperative gastrointestinal bleeding. The most common was vesicovaginal bleeding after pancreatic surgery. A total of 304 embolizations were performed and 24 stent grafts were installed. Results. In 253 (85.2%) patients, it was possible to diagnose the source of bleeding angiographically, and the bleeding was stopped with the help of embolization devices and stent grafts. In 44 (14.8%) patients, it was not possible to accurately diagnose the source of bleeding, and they underwent prophylactic embolization of the most likely source of bleeding. In 12 patients, embolization was repeated: in 6 patients it was performed twice, in 5 patients – three times, and in 1 patient – four times. In 16 (5.4%) patients, including 15 after prophylactic embolization, endovascular hemostasis was ineffective and they required surgical intervention. Conclusions. Endovascular treatment due to its minimal invasiveness, the possibility of repeated use, and the combination of diagnostic and therapeutic stages is the primary method in the treatment of postoperative gastrointestinal bleeding.

Abstract 4134655: Clinical Outcomes of Patients with Alcoholic Cirrhosis and Acute STEMI Undergoing PCI

Original research: Background: The objective is to evaluate the outcomes of percutaneous coronary intervention (PCI) in patients with alcoholic cirrhosis presenting with ST-segment elevation myocardial infarction (STEMI). Methods: We analyzed data from the National Inpatient Sample (NIS) for the years 2016-2020. Our cohort included patients admitted with STEMI and a secondary diagnosis of alcoholic cirrhosis, excluding those under 18 or those not receiving PCI. Propensity score matching using a kernel method was applied to adjust for 22 variables, including patient demographics, hospital characteristics, and comorbid conditions. Results: Among 119,799 patients, 98 had alcoholic cirrhosis. These patients exhibited higher mortality (18% vs. 5%) and longer hospital stays (5.4 days vs. 3.6 days). They also had increased risks of acute blood loss anemia (13% vs. 3.5%) and gastrointestinal bleeding (18% vs. 2%). Additionally, acute kidney injury was more prevalent in the cirrhosis group (25.5% vs. 14%). Although heart failure exacerbation and cardiac arrhythmias were more common, these were not statistically significant (Table 1). Conclusion: Our study indicates a significantly higher mortality rate among patients with alcoholic cirrhosis undergoing PCI for STEMI. These patients are also at increased risk of postoperative bleeding due to compromised liver function and hemostatic abnormalities, as reflected by higher incidences of acute blood loss anemia and gastrointestinal bleeding. Additionally, there is an elevated risk of acute kidney injury post-PCI, highlighting the need for renal-protective strategies. These findings stress the necessity for specialized care, vigilant monitoring, and tailored protocols to address the unique challenges faced by this population, aiming to reduce morbidity and mortality.

Abstract 4137535: Gastrointestinal Bleeding Risk: Diltiazem versus Metoprolol in Patients on Rivaroxaban, Apixaban, or Dabigatran.

Introduction: A recent JAMA study by Ray et al., reported severe bleeding risk among older adults with atrial fibrillation (Afib) receiving apixaban or rivaroxaban along with diltiazem compared to metoprolol. Our investigation extended to evaluating the gastrointestinal (GI) bleeding risk associated with various Xa inhibitors and dabigatran when combined with either diltiazem, or metoprolol among all adults ages 18 and older. Method: We conducted a comparative retrospective cohort study using de-identified patient data obtained from the global network of the TriNetX platform, a comprehensive electronic health records system comprising 120 healthcare systems and more than 147 million patients worldwide. The cohorts were divided into patients treated with diltiazem vs. metoprolol while receiving apixaban or rivaroxaban (Cohort A), patients receiving metoprolol with apixaban vs. rivaroxaban treatment (Cohort B), patients treated with diltiazem with apixaban vs rivaroxaban (Cohort C), and patients treated with diltiazem vs metoprolol who received dabigatran (Cohort D). The risk of gastrointestinal hemorrhage among the cohorts was evaluated. Propensity score matching was employed to balance baseline characteristics between the cohorts, including age, sex, ethnicity, and comorbidities. Results: The risk of GI bleed in patients taking diltiazem with either apixaban or rivaroxaban was 6.3%, while the risk in patients taking metoprolol with either of these Xa inhibitors was 5.7 % (p< 0.0001, 95%CI (1.074,1.111), RR 1.09. In patients taking metoprolol with apixaban, GI bleed risk was 5.4%, compared to 6.4% in those taking metoprolol with rivaroxaban (p< 0.0001, 95% CI (0.838, 0.868), RR 0.85. For patients taking diltiazem with rivaroxaban, GI bleed risk was 7.3%, whereas it was 5.8% in those taking diltiazem with apixaban (p< 0.0001, 95% CI (1.194, 1.265), RR 1.23. Risk of GI bleed in patients taking diltiazem with dabigatran was 7.4%% while it was 6.71% for patients treated with metoprolol and dabigatran (p< 0.0011, CI 95% (1.038,1.16), RR 1.097) Discussion: Global patients’ data in this study suggested similar findings reported by Ray et al. Additionally, among all ages adults with Afib, treatment with metoprolol and apixaban was associated with the lower risk of GI bleed when compared with metoprolol and rivaroxaban. While the highest risk of GI bleed was associated with concurrent diltiazem and dabigatran use.

Use of Intravascular Micro-Axial Left Ventricular Assist Devices as a Bridging Strategy for Cardiogenic Shock: Mid-Term Outcomes

Objectives: Patients in cardiogenic shock (CS) may be successfully bridged using intravascular micro-axial left ventricular assist devices (M-LVADs) for recovery or determination of definitive therapy. Methods: One hundred and seven CS patients implanted with M-LVADs from January 2020 to May 2024 were divided into four groups; group-1: 34 patients (transplant); group-2: 25 patients (LVAD); group-3: 42 patients (postcardiotomy CS (PCCS)); group-4: 6 patients (decision/recovery but excluded from analysis). Multivariable logistic regression and Multivariable Coxregression models identified predictors of early -hospital and late mortality, and Odds ratios (ORs) and hazard ratios (HRs) with p < 0.05, respectively, were considered statistically significant. SPSS 29.0 and Python 3.11.1. were used for analyses. Results: Complications included device-malfunction (6%), gastrointestinal bleed (9%), long-term hemodialysis (21%), axillary hematoma requiring re-exploration (10%), heparin-induced thrombocytopenia (4%) requiring heparin therapy cessation/initiation of argatroban infusion, and non-fatal stroke (11%). Early hospital mortality included 13 patients: 2 in group-1, 1 in group-2, 10 in group-3 (p = 0.02). In the Logistic-Regression model, category of CS requiring an M-LVAD was significant (OR = 4.7, p = 0.05). Patients were followed for 4.5 years (mean follow-up was 23 ± 17 months), and 23 deaths occurred; group-1: 3 patients, group-2: 5 patients, and group-3: 15 patients (p = 0.019). At 4.5 years, actuarial survival was 90.7 ± 5.1% in group-1, 79.2 ± 8.3% in group-2, 62.8 ± 7.7% in group-3 (p = 0.01). In the Cox-Regression model, M-LVAD category (HR = 3.63, p = 0.04), and long-term postoperative dialysis (HR = 3.9, p = 0.002) emerged as predictors of long-term mortality. Conclusions: In cardiogenic shock, mid-term outcomes demonstrate good survival with M-LVADs as bridge to transplant/durable LVADs and reasonable survival with M-LVADs as a bridge to recovery following cardiotomy, accompanied by reduced ECMO usage, and early ambulation/rehabilitation.

Abstract 4144520: Glucagon-like Peptide-1 Receptor Agonists for the Primary Prevention of Major Adverse Cardiac Events in Drug-naïve Type 2 Diabetes: A Propensity-score Analysis

Background: The effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RA) as a first-line agent for the primary prevention of major adverse cardiac events (MACE) in obese patients with diabetes mellitus (DM) is unknown. Research Question: Does initial treatment with GLP-1 RA in obese drug-naïve patients with type 2 DM prevent future MACE? Aims: To examine the association between GLP-1 RA treatment and the primary prevention of MACE in drug-naïve type 2 DM patients with obesity. Methods: A retrospective propensity score-matched (PSM) analysis was conducted using the TriNetX Global database. We implemented a new-user design, including adult overweight/obese patients with drug-naive type 2 DM between January 1 st , 2019 and May 1 st , 2023. Patients with prior heart failure (HF), myocardial infarction (MI), coronary revascularization, stroke, or cardiac arrest were excluded. We compared those starting GLP-1 RA versus starting non GLP-1 RA. Medication starting window spans from the first diagnosis to 3 months afterwards. Patients with insulin were excluded if they had any emergency or inpatient encounters during this window. The primary outcome was incident MACE, defined as any death, decompensated HF, MI, cardiac arrest, or ventricular tachycardia/fibrillation, within 5 years of initial drug dispense. Secondary outcomes were individual MACE. Gastrointestinal bleeding was set as a falsification endpoint. Results: Of 1,245,340 patients with A1c <10% and 293,072 patients with A1c ≥10%, 7,483 and 1,563 patients started on GLP-1 RA as a single agent and part of a combined approach, respectively. After PSM, baseline covariates were balanced between the two treatment groups and no significant differences were observed in the falsification endpoint by treatment arm (Figure) . Compared with non-GLP-1 RA, with the exception of sodium-glucose cotransporter-2 (SGLT2i), starting a GLP-1 RA first was associated with a significant reduction in MACCE, primarily driven by reductions in decompensated HF (Figure) . Conclusions: Initiation of a GLP-1 RA as the first agent for obese patients with drug-naïve type 2 DM was associated with a significant reduction in MACE compared to all other diabetes medications, with the exception of SGLT2i.

Abstract 4127931: Chronic Steroid Use is Associated with Increased Readmission Rates in Patients Admitted with Acute Coronary Syndromes

Introduction: Acute coronary syndrome (ACS) is associated with significant morbidity and mortality. Management of ACS includes percutaneous coronary intervention (PCI) and requires the use of antithrombotic therapy, which increases bleeding risk. Chronic steroid use (CSU) is common for many diseases and is also associated with bleeding risk and impaired wound healing. However, data on outcomes of patients with CSU and AMI are sparse. Methods: Patients admitted for ACS and managed with PCI from 2014 to 2020 with and without CSU were identified using the National Readmissions Database (NRD). In-hospital outcomes include death, arterial thrombosis (composite of ischemic stroke and arterial thromboembolism), and major bleeding (composite of gastrointestinal, intracranial, or post-procedure bleeding or transfusion). Ninety-day readmission outcomes were cardiovascular (CV)-related, bleeding-related and all-cause. Multivariable logistic or Cox proportional hazards were utilized. Results: A total of 1,087,357 patients with ACS were included, of whom, 9,864 (0.9%) had CSU. After multivariable adjustment, there was no significant difference in in-hospital mortality (3.1% vs 3.2%; OR 1.09, 95% CI 0.93-1.26) or risk of arterial thrombosis (3.3% vs 2.8%; OR 0.91, 95% CI 0.81-1.02) between patients with and without CSU. CSU was associated with an increased risk of major bleeding events (8.3% vs 6.0%; OR 1.15, 95% CI 1.06-1.25). CSU was associated with a higher risk of CV-related (10.7% vs 7.5%; HR 1.10, 95% CI 1.02-1.18), bleeding-related (2.3% vs 1.2%; HR 1.28, 95% CI 1.09-1.51), and all-cause 90-day readmissions (23.9% vs 14.9%; HR 1.28, 95% CI, 1.22-1.34). Conclusion: Among patients admitted with ACS who underwent PCI, CSU was associated with increased risk of bleeding during index hospitalization and readmissions for bleeding. Furthermore, CSU was associated with increased risk of 90-day CV and all-cause readmission. Further studies are needed to better characterize this risk.

Abstract 4135095: Outcomes of Atrial Fibrillation Patients with Thrombocytopenia: Insights From a Nationwide Database

Background: While anticoagulation is crucial for atrial fibrillation (AF) patients to prevent ischemic events, those with thrombocytopenia have a potential increased risk of bleeding. This study examines the outcomes of hospitalized AF patients with thrombocytopenia. Methods: The National Inpatient Sample (NIS) from 2016-2020 was analyzed to identify adult patients with AF and thrombocytopenia (using the proper ICD-10 codes). Multivariate logistic and regression analyses were performed after adjusting for multiple patient and hospital confounders to compare outcomes between patients with and without thrombocytopenia. The primary outcome was all-cause inpatient mortality. Secondary outcomes included major bleeding (defined as gastrointestinal, intracranial, pulmonary, or unspecified bleeding), hypovolemic shock, packed red blood cell (pRBC) transfusion, ischemic stroke, length of stay (LOS), and total charges. Results: Among 2,016,244 AF admissions, 75,545 patients (3.75%) had thrombocytopenia. Thrombocytopenia was associated with increased inpatient mortality (adjusted odds ratio [aOR] 2.47, 95% CI 2.21-2.77, p < 0.001). Thrombocytopenia was also associated with increased risk of major bleeding (aOR 1.99, 95% CI 1.8-2.19, p < 0.001), hypovolemic shock (aOR 3.11, 95% CI 2.29-4.24, p < 0.001), pRBC transfusion (aOR 3.07, 95% CI 2.8-3.37, p < 0.001). There was no significant difference in ischemic stroke risk (aOR 0.67, 95% CI 0.37-1.21, p < 0.19) but thrombocytopenia was associated with longer LOS (aMD 1.5 days, 95% CI 1.41-1.59, p < 0.001) and higher total charges (aMD $16,508, 95% CI 14,805-18,211, p < 0.001). Conclusions: Thrombocytopenia in hospitalized AF patients is associated with increased mortality, bleeding risk, and healthcare costs, with no clear impact on ischemic stroke. These findings highlight the need for careful risk-benefit assessment and individualized management strategies for this vulnerable patient population.

Regarding re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy

Regarding re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy

Endoscopic resection of a juvenile jejunum polyp which caused recurrent intestinal bleeding in a 12-month-old child: clinical observation

BACKGROUND: To verify a source of obscure gastrointestinal bleeding leading to iron deficiency anemia is a challenging diagnostic problem. Intestinal polyps can be one of such sources. Sporadic juvenile intestinal polyps are extremely rare at the first year of life. The authors present a clinical case which demonstrates endoscopic diagnostics and resection of a jejunum polyp in a 12-month-old child weighing 6.3 kg. We did not find similar publications in literature. CLINICAL CASE DESCRIPTION: A 12-month-old boy was admitted to our clinic with long-lasting complaints of dark stool and iron deficiency anemia. For the first time, gastrointestinal bleeding symptoms appeared at the age of one month. The child was repeatedly examined, but gastrointestinal bleeding source was not found. The child was prescribed symptomatic therapy for iron deficiency anemia including red blood cell transfusion. At current hospitalization in our clinic an intestinal polyp and transient small intestinal intussusception were suspected at ultrasound examination. The child underwent esophagogastroduodenoscopy, video capsule endoscopy, colonoscopy, laparoscopy. But the source of the bleeding was not found. During the repeated enteroscopy at 40 cm distally to the pylorus a sporadic juvenile jejunum polyp 17×15 mm was found and resected. The postoperative period was uneventful. In 1 month, there were no complaints as for the catamnesis, the child's stool had the usual characteristics, the indicators of "red blood" corresponded to the age norm. CONCLUSION: A sporadic juvenile jejunal polyp may be a cause of obscure recurrent intestinal bleeding in children. Modern intraluminal endoscopy allows not only to put diagnosis, but also to perform a minimally invasive surgical intervention.

Primjena ibuprofena u pedijatrijskoj populaciji

Fever is a common clinical issue, causing concern for parents and being the most frequent reason for visits to pediatricians and pediatric emergency services. Pain accompanies children in various pathological conditions during their growth. Although the importance of pain perception and the use of analgesics is emphasized, pain in the pediatric population is still insufficiently recognized, unlike fever. Ibuprofen is one of the most commonly used medications in the pediatric population, indicated for reducing fever, as well as relieving pain and inflammation in various diseases. The pharmacological properties of ibuprofen indicate a good safety profile with effective results, contributing to its widespread use. The most commonly expected adverse reactions, considering the mechanism of action, such as gastrointestinal bleeding, are rare in children. In a healthy child, there are no adverse effects on the kidneys; however, in conditions of dehydration or kidney disease, fluid volume should be replenished before administering ibuprofen. Given its broad application during fever caused by infection, some conditions are associated with more severe clinical skin and respiratory infections. It is also linked to exacerbations of asthma and a higher risk of asthma if used during pregnancy and the early years of life.This potential association requires additional research to be methodologically confirmed. Therefore, in this paper, through a literature review, we present the effectiveness and safety of ibuprofen use in the pediatric population in various pathological condition.

Bronchiolite inconsolabile, l'addome è trattabile?

Some viruses, such as adenovirus, have been associated with an increased risk of intussusception, although the link in community infections is less clear than with the rotavirus vaccine. The paper presents the case of a 3-month-old infant hospitalized for bronchiolitis, who subsequently developed irritability and gastrointestinal bleeding and refused to eat. The diagnosis of ileocolic intussusception was confirmed via barium enema and required urgent laparotomy for reduction. The post-operative course was uneventful with discharge on the fifth day. This case highlights the importance of monitoring infants with bronchiolitis to find possible signs of intussusception.

Over-the-Scope Clips vs Standard Endoscopic Interventions for First-line Treatment of NVUGI Bleeding: A Meta-analysis of Randomized Trials

Background and Aims: Recently, over-the-scope clips (OTSCs) have been extensively studied for hemostasis of nonvariceal upper gastrointestinal bleeding (NVUGIB). Our goal was to compare the efficacy of OTSCs with standard endoscopic interventions (SEIs) as first-line treatments. Methods: A comprehensive search of electronic databases was performed to identify Randomized Clinical Trials (RCTs) comparing OTSCs with SEIs as first-line therapy for NVUGIB. This search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Out of 819 reviewed studies, 5 RCTs comprising a total of 555 patients (277 OTSCs vs. 278 SEIs) were included. The OTSC group had a lower 30-day rebleeding rate (Risk Ratio [RR]: 0.43; 95% Confidence Interval [CI]: 0.24, 0.77; I²: 0%; p = 0.004) and a higher clinical success rate (RR: 1.19; 95% CI: 1.11, 1.28; I²: 0%; p < 0.00001). There was no significant difference in technical success (RR: 1.06; 95% CI: 0.98, 1.14; I² = 73%; p = 0.13), 30-day all-cause mortality (RR: 0.50; 95% CI: 0.22, 1.14; I²: 0%; p = 0.10), need for further intervention (RR: 1.22; 95% CI: 0.43, 3.47; I²: 0%; p = 0.71), or length of hospital stay (Mean Difference: 0.31; 95% CI: -1.08, 1.70; I²: 0%; p = 0.66). The risk of bias, which was assessed using the Cochrane Risk of Bias 2.0 tool, indicated some concerns of bias. Conclusion: OTSCs are more efficient than SEIs as a first-line treatment in terms of rebleeding within 30 days and clinical success rates.

Acute Hemorrhagic Rectal Ulcer Presenting With Severe Lower Gastrointestinal Bleeding: A Case Report of an Emerging Entity

Acute Hemorrhagic Rectal Ulcer Presenting With Severe Lower Gastrointestinal Bleeding: A Case Report of an Emerging Entity

Venous intestinal ischemia of fungal origin as a cause of intestinal obstruction in immunocompromised patients: case report and literature review

BackgroundMucormycosis is a highly lethal opportunistic fungal disease caused by ubiquitous molds of the order Mucorales, with Rhizopus, Lichtheimia and Mucor being the most common genera. This rare disease primarily affects immunocompromised patients, with presentations ranging from rhino-orbito-cerebral infections to disseminated mucormycosis with angioinvasion, leading to thrombosis and tissue infarction. Gastrointestinal mucormycosis is the least common clinical presentation and is believed to be secondary to spore ingestion. It can involve multiple components of the gastrointestinal tract, such as the stomach, liver, ileum, and colon, with nonspecific manifestations, including pain, nausea, vomiting, and abdominal distension. The initial clinical presentation may even manifest as gastrointestinal bleeding due to gastric ulceration or intestinal perforation.Case presentationHere we present the case of a 48-year-old male patient with a 9-year history of human immunodeficiency virus (HIV) infection who was hospitalized in the context of febrile neutropenia and whose acute respiratory infection was documented; therefore, antibiotic treatment was initiated. However, due to persistent febrile peaks and peripheral blood showing documentation of multilineage cytopenias, a bone marrow biopsy was performed, compatible with presenting features of marrow myelodysplasia. During hospitalization, the patient presented left flank abdominal pain, and an abdominal computed tomography (CT) scan revealed signs of intussusception of a small bowel loop at the distal jejunum level, leading to intestinal obstruction with ischemic progression, requiring ileectomy (60 cm). Histopathological analysis of the resected intestine revealed severe transmural ischemic changes associated with venous thrombosis due to fungal structures, with histochemical studies demonstrating the presence of zygomycete (Mucor) fungal structures, leading to the initiation of treatment with amphotericin B. However, despite treatment, the patient experienced progressive clinical deterioration with persistent fever and ventilatory failure, with follow-up tests showing absolute neutropenia and blood cultures positive for yeast, leading to death 52 days after admission.ConclusionsThe diagnosis of intestinal mucormycosis may be delayed due to the lack of specificity of the signs and symptoms. Pathologists as well as histopathological studies are essential for timely treatment.

Transcatheter arterial embolization of nonvariceal gastrointestinal bleeding with n-butyl cyanoacrylate or coils: a systematic review and meta-analysis

This report is of a systematic review and meta-analysis evaluating the efficacy and safety of transcatheter arterial embolization (TAE) for nonvariceal gastrointestinal bleeding (GIB) with n-butyl cyanoacrylate (NBCA) or coils as the primary embolic agent. The primary outcome was the clinical success rate. The secondary outcomes were technical success rates, 30-day rebleeding rates, major complication rates, and 30-day overall mortality rates. A systematic search was performed in PubMed, Embase, and Cochrane Library. Articles included had been published in English from January 2000 to August 2023 and assessed patients with nonvariceal upper and lower GIB (UGIB and LGIB) who received TAE with NBCA or coils. Single-arm meta-analyses were performed for these outcomes. Subgroup analyses comparing NBCA and coils were conducted if there were more than 10 articles selected for each outcome. Thirty-seven articles were selected for analysis. The pooled rates of TAE for UGIB and LGIB were clinical success 73.0% and 76.5%, technical success 94.9% and 91.4%, 30-day rebleeding 25.0% and 17.1%, major complications 3.5% and 10.0%, and 30-day overall mortality 20.7% and 11.4%, respectively. The subgroup analysis showed a significant difference only for the technical success rates of LGIB between NBCA and the coils (p < 0.001). The systematic review and meta-analysis indicate that TAE with NBCA or coils as the primary embolic agent is safe and effective for both UGIB and LGIB.

Mean platelet volume/platelet count ratio can predict the recurrence-free survival rate of patients after complete resection of gastrointestinal stromal tumors

PurposeThe aim of this study is to compare mean platelet volume/platelet count ratio (PVPR) and other indicators’ predictive abilities. Simultaneously, a new nomogram for predicting recurrence-free survival (RFS) after gastrointestinal stromal tumors (GISTs) R0 resection was developed.MethodsFrom January 2010 to July 2019, 295 patients with GIST who were operated on at Harbin Medical University Cancer Hospital were retrospectively reviewed. With a 4-year RFS as the end point, using the Kaplan–Meier methods and log rank test, and then conducting Cox regression analysis, we compared and identified meaningful indicators for predicting prognosis. Finally, a nomogram was developed and validated using calibration curves.ResultsThe receiver operating characteristic curve indicated that a cutoff point of 0.044 was the ideal threshold for PVPR, and patients were divided into a high-PVPR group (≤0.044) and a low-PVPR group (&amp;gt;0.044). Kaplan–Meier curves suggested that PVPR&amp;gt;0.044 had obvious associations with better RFS (p &amp;lt; 0.001). In accordance with multivariate analysis, PVPR (&amp;gt;0.044 vs. ≤0.044) (p = 0.005), National Institutes of Health (NIH) risk category (p &amp;lt; 0.001), and Ki-67 (p = 0.005) were the independent prognostic indicators of RFS. Tumor size, gastrointestinal bleeding, mitotic index, NIH risk category, CD34, and Ki-67 all exhibited an obvious correlation with PVPR (all p &amp;lt; 0.05). The nomogram’s probability of concordance was 0.823, indicating that the nomogram predictions were well calibrated.ConclusionIn GISTs, RFS can be independently predicted by PVPR. Patients with higher PVPR have better RFS. The nomogram including PVPR could be used to assist clinical treatment decision-making.

Multidisciplinary Guidance for the Management of Severe Bleeding on Oral Anticoagulation: An Algorithm for Practicing Clinicians.

Bleeding complications associated with oral anticoagulant (OAC) frequently lead to emergency department visits and hospitalization. Short-term all-cause mortality after severe bleeding is substantial ranging from about 10% for gastrointestinal bleeding (the most frequent single site) to about 50% for intracranial bleeding. A protocolized, multidisciplinary approach to bleeding ensures is needed to (i) rapidly identify of patients at risk of adverse outcomes, (ii) optimize delivery of supportive measures, (iii) treat the source of bleeding, and (iv) administer anticoagulant reversal or hemostatic therapies judiciously for patients most likely to benefit. We convened a multidisciplinary panel of experts (emergency medicine, gastroenterology, general internal medicine, hematology, neurology, pharmacy, thrombosis,) to review the literature and provide practical guidance including a corresponding algorithm for use at the point of care to assist clinicians in the management of patients with acute severe OAC-related bleeding.

Neoadjuvant immune checkpoint inhibitor reduced recurrence in operable NSCLC patients with pathological complete response: a retrospective analysis

BackgroundThis study aimed to evaluate if neoadjuvant immune checkpoint inhibitor (ICI) plus chemotherapy (CT) reduced tumor recurrence after surgery than neoadjuvant CT alone in non–small cell lung cancer (NSCLC) patients with pathologic complete response (pCR).MethodsFrom January 1st 2019 to April 30th 2022, 16 NSCLC patients with pCR who received both neoadjuvant ICI and CT were designated as ICI/CT group. Another 8 patients, who received neoadjuvant CT alone, were designated as CT group. The tumor recurrence and patients’ survival status were analyzed.ResultsSquamous cell carcinoma was the predominant histology type in both groups. The CT group had higher percentage of patients who received adjuvant CT than the ICI/CT group (100% vs. 75%, p = 0.046). All patients had been followed up for at least 20 months. At 20 months after surgery, the ICI/CT group had a tumor recurrence rate of 6.25%, which was significantly lower than 37.5% recurrence rate of the CT group. One patient of the CT group died of gastrointestinal hemorrhage and severe anemia at 11 months after surgery, and no patient in the ICI/CT group died. During adjuvant therapy, the ICI/CT group had significantly lower risk of anemia (12.5% vs. 50%) than the CT group (p = 0.046).ConclusionThe study found that in NSCLC patients with pCR, neoadjuvant ICI reduced tumor recurrence rate. This indicated that like in advanced stage NSCLC, the ICI might bring similar long-term anti-tumor effect in operable NSCLC patients.