Incidence Of Gastrointestinal Bleeding Research Articles

Expression of matrix metalloproteinase in patients with Alzheimer and mechanism of huangqi granule (astragalus saponins) intervention

This study investigated expression of matrix metalloproteinases in senile dementia patients and mechanism of Huangqi granule intervention. 78 cases of senile dementia patients were selected as observation group from June 2017 to June 2019, while 62 cases of healthy people were enrolled as control group. Blood samples were collected after admission and levels of matrix metalloproteinase 3,9,13 (MMP-3,9,13) were determined. The observation group was randomly and equally assigned into donepezil hydrochloride group and combined drug group. Mental state examination (MMSE) and Boston diagnostic aphasia test (BDAE) were used to compare the two groups. Montreal Cognitive Assessment (MoCA), Dementia Scale (HDS) scores, biochemical index levels and drug safety were also used. MMP-2, MMP-9 and urinary plasminogen activator levels in observation group were higher and ZO-1 was lower than control group along with higher MMP-3,9,13 mRNA levels (p < 0.05) which were reduced after 3 months of treatment. MMSE scale, BDAE, MoCA, and HDS scores in the combined drug group were higher after 3 months of treatment (p < 0.05). The level of NSE (neuron-specific enolase) was higher and SOD level was lower than in the donepezil hydrochloride group (p < 0.05); nausea and vomiting, muscle spasms, insomnia bradycardia and gastrointestinal bleeding incidence in two groups showed no differences (p > 0.05). The intervention of Huangqi granules can improve cognitive function of patients, inhibit matrix metalloproteinase, thereby improving the level of biochemical indicators without increasing the incidence of complications.

Impact of Fried Frailty Phenotype on Postoperative Outcomes After Durable Contemporary Mechanical Circulatory Support: A Single-Center Experience.

Frailty is prevalent in advanced heart failure patients and may help distinguish patients at risk of worse outcomes. However, the effect of frailty on postoperative clinical outcomes is still understudied. Therefore, we aim to study the relationship between frailty and postoperative clinical outcomes in patients undergoing long-term mechanical circulatory support (MCS). Forty-six patients undergoing durable MCS (left ventricular assist device and total artificial heart) placement at our medical center were assessed for frailty pre-implant. Frailty was defined as ≥ 3 physical components of the Fried frailty phenotype. Our primary endpoint is 1 year of survival post-implant. Secondary endpoints include 30-day all-cause rehospitalization, pump thrombosis, neurological event (stroke/transient ischemic attack), gastrointestinal bleeding, and driveline infection within 12 months post-MCS support. Of the 46 patients, 32 (69%) met the criteria for frailty according to Fried. The cohort's median age was 67.0 years. The frail group had statistically significant lower left ventricular ejection fraction (LVEF) (11% vs. 20%, P = 0.017) and lower albumin (3.5 vs. 4.0 g/dL, P = 0.021). The frail cohort also had significantly higher rates of comorbid chronic kidney disease (47% vs. 7%, P = 0.016). There were no differences between the frail vs. non-frail group in terms of 30-day readmission rates (40% vs. 39%, P = 0.927) and 1-year post-intervention survival (log-rank, P = 0.165). None of the other secondary endpoints reached statistical significance, although the incidence of gastrointestinal bleed (24% vs. 16%, P = 0.689) and pump thrombosis (8% vs. 0%, P = 0.538) were higher in the frail group. Preoperative Fried frailty was not associated with readmission at 30 days, mortality at 365 days, and other postoperative outcomes in long-term durable MCS patients. Findings may need further validation in larger studies.

Abstract 15372: Machine Learning Distinguishes Continuous Risk of Gastrointestinal Bleeding, Stroke, and Death in Ambulatory Lvad Patients

Introduction: Advanced data analytics are needed to reliably predict bleeding and thrombotic risk in ambulatory left ventricular assist device (LVAD) patients. Hypothesis: Machine learning techniques can be used to predict risk of gastrointestinal bleeding (GIB), stroke, or death in ambulatory LVAD patients. Methods: HeartMate 3 TM LVAD recipients from the MOMENTUM 3 studies with up to 2-year follow-up were included. A multistate model was developed with 5-fold cross-validation to characterize the continuous probability of events after discharge. Model features included pre-implant, index implant, and short- and long-term post-implant clinical features. 85% of patients were used for model derivation and 15% for validation. Model performance was assessed with area under the curve (AUC). With the model features, a risk stratification tool was created by dividing patients’ into terciles of predicted risk. Results: Among 2,056 LVAD patients who survived to hospital discharge, the median age was 59.4 yrs (20.4% Female, 28.6% Black). At 2-years, the incidence of GIB, Stroke, and Death was 25.6%, 6.0% and 12.3%, respectively. Unique models including pre-implant, implant and post-implant features were created for GIB (Figure A), Stroke and Death. In ambulatory LVAD patients, the model could predict 30-day risk of GIB at any time post-implant which was 26.9%, 2.6% and 0.8% in high, medium and low-risk patients respectively (Figure B). Similar risk prediction was performed for stroke and death. The cross-validated AUC in the derivation cohort was 0.70, 0.69, and 0.85 for GIB, stroke, and death respectively. Conclusion: We developed an innovative risk tool informed by machine learning techniques that predicts risk of GIB, stroke, and death at any 30-day interval in ambulatory LVAD patients with readily available clinical data. The model allows for risk stratification that accurately predicts future events and may be useful to guide clinical decision making.

Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic

During the last few years, a progressive higher proportion of patients have had upper gastrointestinal bleeding (UGIB) related to antithrombotic therapy. The introduction of direct oral anticoagulant (DOAC) and COVID-19 pandemic may change the incidence, mortality, and follow-up, especially in patients at high risk of bleeding. We studied the use of anti-thrombotic therapy (AT) in patients with upper gastrointestinal bleeding for 5 years (January 2017-December 2021) including Covid-19 pandemic period (March 2020-December 2021). We analyzed mortality rate, rebleeding rate and need for transfusion in patients with AT therapy compared with those without AT therapy and risk factors for mortality, and also the incidence of gastrointestinal bleeding in patients admitted for COVID-19 infection. A total of 824 patients were admitted during Covid-19 pandemic period and 1631 before pandemic period; a total of 426 cases of bleeding were recorded in patients taking antithrombotic therapy and the frequency of antithrombotic therapy in patients with UGIB was higher in pandemic period (24.39% versus 13.8%). Unadjusted mortality was 12.21%, similar with patients with no antithrombotic treatment but age-adjusted mortality was 9.62% (28% lower). The rate of endoscopy was similar but fewer therapeutic procedures were required. Mean Hb level was 10% lower, and more than 60% of patients required blood transfusion. Mortality was similar compared with patients with no antithrombotic therapy, fewer therapeutic endoscopies were performed and similar rebleeding rate and emergency surgery were noted. Hb level was 10% lower and a higher proportion of patients required blood transfusions. Mortality was higher in DOAC treatment group compared with VKA patients but with no statistical significance. The rate of upper gastrointestinal bleeding in Covid-19 positive hospitalized cases was 0.58%. The mortality risk in multivariate analysis was associated with GB score, with no endoscopy performed, with obscure and variceal bleeding and with LMWH versus VKA therapy.

Incidence of Gastrointestinal Bleeding After Transesophageal Echocardiography Use in Orthotopic Liver Transplantation.

The risk of upper gastrointestinal bleeding (UGIB) after transesophageal echocardiography (TEE) in patients with high grade esophageal varices (EV) that are undergoing Orthotopic Liver transplantation (OLT) is poorly understood. This was a retrospective single-centre cohort study in all patients that underwent OLT at Queen Elizabeth Hospital Birmingham between September 2016 and September 2018. The primary outcome was to determine the incidence of UGIB in patients that have undergone OLT with EV that received TEE. 401 patients were included in the study, of which 320 (80%) received TEE. The incidence of post-operative UGIB in patients that received TEE was 1.6% (5/320) in the entire cohort: 2.7% (4/149) in patients with no evidence of EV and 0.6% (1/171) in patients with EV. UGIB occurred in 1 patient with grade 2 EV and did not occur in patients with grade 1 or 3 EV. The incidence of UGIB in patients that received TEE was not statistically different to patients that did not: 1.6% (5/320) vs. 3.7% (3/81) p = 0.218. In conclusion, in patients that underwent OLT, intra-operative TEE use was associated with low rates of UGIB, even in cohorts with high grade EV. This suggests that TEE is a relatively safe method of haemodynamic monitoring in patients undergoing OLT.

Effects of reduced portosystemic flow on hepatic myelopathy in patients with cirrhosis after TIPS

Objective: To investigate the impact of a reduced portacaval shunt on hepatic myelopathy (HM) in patients with cirrhosis after a transjugular intrahepatic portosystemic shunt (TIPS). Methods: Patients who developed HM after receiving TIPS at the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to June 2018 were retrospectively analyzed. HM severity was quantified by clinical spasticity index (CSI) and Fugl-Meyer Assessment (FMA) of the lower extremity. Clinical manifestations were combined with grades Ⅰ-Ⅳ. HM patients were divided into drug treatment (group A) and flow restriction group (group B) according to different treatment methods. The changes in CSI and FMA of the lower extremity after treatment were statistically analyzed in the two groups. P<0.05 was considered a statistically significant difference. Results: A total of 421 cases of cirrhosis who underwent TIPS were enrolled. Among them, 30 developed HM, with 22 in group A and 8 in group B. The incidence of HM after TIPS surgery was about 7.13%. After treatment, CSI was gradually increased and FMA of lower extremity was gradually decreased in group A, while vice-versa in group B. CSI in the two groups were differed significantly at 6, 12, 18, and 24 months after treatment (P<0.05), while the difference in FMA of the lower extremity was statistically significant at 12, 18, and 24 months after treatment (P<0.05). CSI was decreased and FMA of lower extremity was increased after treatment in patients with group A HM grade I. CSI, and FMA of lower extremity changes were statistically significant (P<0.05) when compared with patients with HM grades Ⅱ-Ⅳ. The incidence of hepatic encephalopathy was significantly lower in group B than that in group A (P=0.034), but there was no statistically significant difference between the two groups in the incidence of gastrointestinal bleeding, ascites, infection, MELD score and mortality. Conclusion: A reduced portacaval shunt can improve HM in patients with liver cirrhosis after TIPS, and drug therapy alone is effective for patients with early HM grade I.

Post-Implant Phosphodiesterase-5 Inhibitors in Patients with Left Ventricular Assist Device: A Systematic Review and Meta-Analysis.

Background: Despite the improvement in left ventricular assist device (LVAD) technology and the advent of third-generation LVADs, hemocompatibility-related events remain a significant issue. Therefore, new pharmacological treatments are necessary to optimize patient management and to further reduce hemocompatibility-related events. The purpose of the present systematic review and meta-analysis was to summarize the existing data regarding the safety and efficacy of post-implant phosphodiesterase-5 inhibitors (PDE-5i) on hemocompatibility-related events. Methods: Among the 258 articles in Pubmed, Scopus, and CENTRAL that were retrieved (1990–2022), 15 studies were included in the qualitative synthesis, and 9 studies were included in the quantitative synthesis. The fixed-effects model was used because it is statistically sound for combining a very small number of studies. The primary endpoint of the study was all-cause mortality, whereas the secondary endpoints were ischemic stroke, pump thrombosis, and gastrointestinal bleeding. Results: Mortality was significantly lower in the PDE-5i group vs. the control group (OR: 0.92 [95% CI: 0.85, 0.98]; p = 0.02). The secondary endpoints ischemic stroke (OR: 0.87 [95% CI: 0.78, 0.98]; p = 0.02) and pump thrombosis (OR: 0.90 [95% CI: 0.82, 0.99]; p = 0.04) were also lower in the PDE-5i group. The incidence of gastrointestinal bleeding was significantly higher in patients with LVAD receiving PDE-5i (OR: 1.26 [95% CI: 1.11, 1.44]; p < 0.01). In the overall analysis, the heterogeneity of outcomes was low, except for pump thrombosis. Conclusions: The use of PDE-5i post-implant was associated with lower mortality and thrombotic events but with a higher risk of gastrointestinal bleeding.

Red blood cell distribution width predicts gastrointestinal bleeding after coronary artery bypass grafting

BackgroundRed blood cell distribution width (RDW) is highly associated with adverse clinical outcomes in many diseases. The present study aimed to evaluate the relationship between RDW and gastrointestinal bleeding (GIB) after isolated coronary artery bypass grafting (CABG).MethodsThis was a retrospective observational study that included 4473 patients who received CABG, and all the data were extracted from the Medical Information Mart for Intensive Care III database. Data collected included patient demographics, associated comorbid illnesses, laboratory parameters, and medications. The receiver operating characteristic (ROC) curve was used to determine the best cutoff value of RDW for the diagnosis of GIB. Multivariable logistic regression analysis was used to analyze the relationship between RDW and GIB.ResultsThe incidence of GIB in patients receiving CABG was 1.1%. Quartile analyses showed a significant increase in GIB incidence at the fourth RDW quartile (> 14.3%; P < 0.001). The ROC curve analysis revealed that an RDW level > 14.1% measured on admission had 59.6% sensitivity and 69.4% specificity in predicting GIB after CABG. After adjustment for confounders, high RDW was still associated with an increased risk of GIB in patients with CABG (odds ratio = 2.83, 95% confidence interval 1.46–5.51, P = 0.002).ConclusionsOur study indicates that the elevated RDW level is associated with an increased risk of GIB after CABG, and it can be an independent predictor of GIB. The introduction of RDW to study GIB enriches the diagnosis method of GIB and ensures the rapid and accurate diagnosis of GIB.

Comparison of the Degree of Gastric Mucosal Injury between Patients Who Are Receiving Dual Antiplatelet Therapy or Single Antiplatelet Therapy.

Background: Patients taking low-dose aspirin have a higher incidence of gastroduodenal ulcers and higher risk of upper gastrointestinal bleeding than patients who do not. Thienopyridine antiplatelet agents may similarly cause bleeding gastroduodenal erosions and ulcers. The incidence of gastrointestinal bleeding is reported to be higher when these antithrombotic drugs are used in combination. Until now, most studies have focused on bleeding, and no study has compared the degree of gastric mucosal injury between patients receiving dual antiplatelet therapy (DAPT) and those receiving single antiplatelet therapy (SAPT) in real-world clinical practice. Aim: Our objective was to compare the degree of gastric mucosal injury in patients taking low-dose aspirin in combination with clopidogrel (one of the thienopyridine antiplatelet agents) with that of patients who were taking aspirin or clopidogrel as a single agent. Methods: Patients who were taking aspirin and/or clopidogrel and who underwent scheduled esophagogastroduodenoscopy between April 2015 and March 2020 were enrolled in this study. Endoscopic images were reviewed retrospectively, and the degree of gastric mucosal injury was assessed with the modified Lanza score (m-Lanza score). The m-Lanza score was compared between DAPT patients taking aspirin and clopidogrel and SAPT patients taking either aspirin alone or clopidogrel alone. Results: The m-Lanza scores of the DAPT group, the aspirin group, and the clopidogrel group were 1.67 ± 1.81 (mean ± standard deviation), 0.95 ± 1.61, and 0.72 ± 1.29, respectively. The m-Lanza score of the DAPT group tended to be higher than that of the aspirin group (p = 0.06) and was significantly higher than that of the clopidogrel group (p = 0.03). Conclusion: The degree of gastric mucosal injury in DAPT patients was significantly higher than that in patients using clopidogrel alone and tended to be higher than that in patients using aspirin alone in real-world clinical practice.

Impact of digoxin utilization on clinical outcomes following left ventricular assist device implantation.

We aimed to assess the impact of digoxin use following left ventricular assist device (LVAD) implantation on clinical outcomes. Patients implanted with continuous flow LVADs at a single academic medical center and survived to initial hospital discharge were included in the analysis (n = 346). Clinical events were captured at a maximum of 2 years of follow up. Digoxin use was defined as 30-day continuous use post-LVAD. Negative binomial regression and Kaplan-Meier method were used to assess the association between digoxin use and clinical outcomes. Mean age of the cohort was 56 years (±13) and 23% (79/346) were female sex. Digoxin was used in 144 patients (41.6%) for a median of 268 days (IQR 154, 616). Digoxin use was associated with a significant reduction in cumulative incidence of gastrointestinal bleeding (GIB) (15% vs 26%, p = 0.004). After adjusting for age, hypertension, post-operative hemoglobin, RDW, potassium, and GFR, and use of angiotensin receptor/neprilysin inhibitor, there remained a significant 47% reduction in GIB incidence in patients treated with digoxin. There was no significant difference in cumulative incidence in right ventricular failure (RVF) between the two groups. There was no difference in overall 2-year survival between groups. Digoxin use was associated with reduction in GIB events, but not in RVF or mortality. Further studies are needed to confirm these findings and to investigate optimal timing and patient population.

Bleeding events in the emergency department with warfarin versus novel oral anticoagulants: A five-year analysis.

Although warfarin is the most effective treatment approved to prevent atrial fibrillation-associated stroke, it remains underused in clinical practice due to patient noncompliance. Therefore, novel oral anticoagulants (NOACs) have been developed. This study aimed to identify bleeding complications in patients who were taking oral anticoagulants and compare the rates of major and minor bleeding events between NOACs and warfarin groups. We conducted a retrospective, observational study of warfarin- and NOAC-treated patients who presented to an emergency department between January 2015 and December 2019 with bleeding events. We compared patients with major and minor bleeding in terms of age, gender, comorbid diseases, type of anticoagulant, and site of bleeding. An electronic search yielded 95 (21.9%) cases of patients taking a NOAC (i.e., dabigatran [19], rivaroxaban [45], apixaban [29], or edoxaban [6]) and 354 taking warfarin. There were no significant differences between the warfarin and NOACs groups in the frequency of minor bleeding complications. Similarly, there were no significant differences between the groups in the frequency of major bleeding complications. No significant difference in intracranial bleeding was seen between the NOACs- and warfarin-treated patients, although the incidence of gastrointestinal bleeding was significantly higher in the NOACs (P = 0.102 and P = 0.021, respectively). Our findings indicate that rates of major and minor bleeding complications in patients taking NOACs are similar to those in patients taking warfarin. While warfarin was associated with fewer complications than NOACs in terms of gastrointestinal bleeding, the risk of intracranial bleeding, was similar between the groups.

On the prevention of gastrointestinal bleeding in burned patients treated with omeprazole

Background: The incidence of gastrointestinal bleeding in patients with severe burns can reach up to 10%.Objective: Evaluation of the risk factors for gastrointestinal bleeding and of the effectiveness of stress ulcer prophylaxis in patients with severe burns receiving proton pump inhibitors.Material and methods: The study included the results of treatment of 270 patients with burns more than 10% of total body surface area (TBSA), in whom 13 potential risk factors for gastrointestinal bleeding were studied. All patients received omeprazole therapy with 40 mg № 1 intravenous or 20 mg № 2 orally. The data obtained were processed in Microsoft Office Excel 2007 and IBM SPSS 20.0.Results: Significant risk factors for gastrointestinal bleeding were hypotension requiring treatment with vasopressors (dopamine ≥ 10 μg/kg/min or norepinephrine ≥ 0.5 μg/kg/min) for 2 or more days (χ2 = 5.126; p = 0.024) and full thickness burns with more than 50% of total body surface area (χ2 = 7.031; p = 0.008). The incidence of gastrointestinal bleeding was 4%. These bleedings were hemodynamically insignificant; in all cases, acute ulcers were the cause for them. There were no recurrences of bleeding and no repeated endoscopy or surgical treatment was required. The developed bleeding did not have a significant effect on mortality.Conclusion: Using proton pump inhibitors minimizes the frequency and intensity of gastrointestinal bleeding and also prevents lifethreatening complications during their development. More complex prevention of stress ulceration is necessary for patients with full thickness burns more than 50% of TBSA which develop hypotension requiring long‑term vasopressor therapy.

Pre-operative sarcopenia is predictive of recurrent gastrointestinal bleeding on left ventricular assist device support: A multicenter analysis.

Whether pre left ventricular assist device (LVAD) sarcopenia is associated with higher incidence of gastrointestinal bleeding (GIB) on LVAD support remains unknown. To study the association between preoperative sarcopenia and post LVAD GIB events, we performed a retrospective, multi-centered study including patients with chest CTs performed ≤ 3 months prior to LVAD implantation at the University of Minnesota (n=143) and Houston Methodist Hospital (n=133). To quantify sarcopenia, unilateral pectoralis muscle mass indexed to body surface area (PMI) and attenuation (approximated by mean Hounsfield units; PHUm) were measured on pre-operative chest CT scans. Negative binomial regression analyses were performed to determine the association between pectoralis muscle measures and number of GIB events to 2 years of LVAD support. The study cohort included 276 LVAD recipients with 43 % designated as bridge to transplant at the time of LVAD implantation. High pectoralis muscle mass and tissue attenuation were both protective against GIB events. Each 5 unit increase in PHUm was associated with an adjusted 19 % reduction in the incidence rate of GIB (95 % CI 7-29 %, p=0.002). Each unit increase in PMI was associated with an adjusted 17 % reduction in the incidence of GIB (95 % CI 1- 29 %, p=0.04). The models were adjusted for age, sex, INTERMACS profile, bridge to transplant status, creatinine, albumin and implanting center. Preoperative sarcopenia, as quantified by pectoralis muscle size and attenuation, was associated with the development of recurrent GI bleeding after LVAD implantation. These CT quantitative measures appear to predict not only early mortality but morbidity on LVAD as well.

Risk factors of pediatric venoarterial extracorporeal membrane oxygenation-related gastrointestinal bleeding after open-heart surgeries.

To analyze the risk factors for gastrointestinal (GI) bleeding in congenital heart disease (CHD) patients supported with venoarterial extracorporeal membrane oxygenation (V-A ECMO) after open-heart surgery. A retrospective analysis was performed on children with (GI group: 26 cases) and without (control group: 122 cases) GI bleeding during ECMO at Shanghai Children's Medical Center from 2017 to 2020. Clinical data were analyzed and compared between groups to search for risk factors for GI bleeding. A total of 148 cases were included in the study. The overall incidence of GI bleeding was 17.6% (26/148). The in-hospital mortality rate in the GI group was 61.5% (16/26) versus 45.9% (56/122) in the control group. Twenty-six patients suffered cardiac arrest before ECMO support. The GI bleeding incidence among extracorporeal cardiopulmonary resuscitation (ECPR) patients was 50.0% (13/26) versus 28.7 (35/122) among non-ECPR patients, p=0.035. The activated clotting time (ACT) was 201.40 s (180.47 to 247.27) in the GI group versus 177.63 s (167.79 to 203.13) (p=0.050) in the control group. The lowest antithrombin level (Min AT) was 27.00 ± 13.07% versus 37.62 ± 15.18 (p=0.001). The pH and lactate levels before ECMO (Pre PH and Pre Lac) were lower in the GI group than in the control group. (7.31 ± 0.23 vs. 7.35 ± 0.17, p=0.035 and 12.2 ± 6.11 vs. 7.78 ± 6.67, p=0.003). Liver function during ECMO support was statistically worse in the GI group than in the control group. Multivariate analysis showed that Pre Lac (OR=1.106 [1.018-1.202], p=0.0016) was an independent risk factor for GI bleeding. ROC analysis of Pre Lac and GI bleeding showed an area under the curve (AUC) of 0.700 (95% CI: 0.600-0.800, p=0.002) and a cutoff value of 9.30 mmol/L (sensitivity, 73.1%; specificity, 62.7%). As the first study in this field, the probability of GI bleeding and related mortality was found to be high in children supported with V-A ECMO after open-heart surgery. A higher lactate level before ECMO was an independent risk factor for GI bleeding.

Protein Biomarkers Predict Risk of Gastrointestinal Bleeding in Left Ventricular Assist Device Patients

<h3>Purpose</h3> Recently, protein biomarkers such as N-terminal B-type natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) have been shown to predict risk for gastrointestinal bleeding (GIB) and stroke in atrial fibrillation. This study aims to assess the validity of these biomarkers in predicting the incidence of stroke or GIB in LVAD recipients. <h3>Methods</h3> Prospective LVAD patients were enrolled into the PREVENtion of Heartmate II Pump Thrombosis through Clinical Management (PREVENT) at 24 sites across the U.S along with patients from Inova Heart and Vascular Institute and Allegheny Health Network from 2014-2019. NT-proBNP and GDF-15 were measured before LVAD. Time to first stroke or GIB within 6-months was analyzed in relationship to the median biomarker concentration. <h3>Results</h3> A total of 470 patients were included in the analysis. Patients had the following characteristics: median patient age 60 years (IQR: 52-67), 80% male, 20% female, 75% White, 20% Black, 30% diabetes mellitus and 34% atrial fibrillation. Most patients had non-ischemic cardiomyopathy (46%) and were INTERMACS profile 2-3 (67%). At 6-months, 99 patients had a GIB (21%) and 32 had a stroke (7%). The median NT-proBNP was 2,551pg/ml (1,396-5,386) and GDF-15 was 5,000pg/ml (2,917-8,442). When patients were separated by the median biomarker concentrations, no difference in the incidence of stroke was noted (<i>p</i>=0.8). Similarly, the incidence of GIB with higher NT-proBNP concentrations was not significant (<i>p</i>=0.16, Figure A). Higher GDF-15 concentrations were associated with a higher incidence of GIB (<i>p</i>=0.02, Figure B). Patients with elevated GDF-15 levels had an incidence of GIB of 23% compared to 15% in patients with lower concentrations. <h3>Conclusion</h3> Elevated levels of GDF-15 predict risk of GIB following LVAD implant. These data highlight the ability of novel biomarkers to predict complications that could potentially guide the selection of antithrombotic therapy after LVAD placement.

Meloxicam versus Celecoxib for Postoperative Analgesia after Total Knee Arthroplasty: Safety, Efficacy and Cost.

Introduction:Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as part of multimodal analgesia in total knee arthroplasty (TKA). Selective cyclooxygenase (COX)-2 inhibitors (e.g., celecoxib) are believed to have fewer gastrointestinal (GI) adverse effects than nonselective NSAIDS. Meloxicam is less selective for COX-2 than celecoxib is and partially inhibits COX-1 at higher doses. Nonetheless, some surgeons prefer using nonselective NSAIDs because of their lower expense.Methods:Four thousand nine hundred ninety-four patients who underwent TKA between January 2015 and February 2020 and took either celecoxib (n = 3,174), meloxicam 15 mg/d (n = 1,819), or meloxicam 7.5 mg/d (n = 451) were studied. Mutlimodal postoperative analgesia protocols were otherwise similar. GI bleeding and wound complication incidence were determined, as well as average 30-day prescription costs.Results:GI bleeding incidence was similar in the three cohorts (P = 0.4). The incidence of wound complications did not significantly differ between the groups: 0.06%, 0.07%, and 0.22% in the celecoxib, meloxicam 15 mg/d, and meloxicam 7.5 mg/d groups, respectively (P = 0.06). Subsituting meloxicam for celecoxib results in an average savings of $183 per prescription.Discussion:Meloxicam used at higher doses (15 mg/d) does not markedly increase the risk of GI or wound complications associated with COX-1 inhibition and is less costly for multimodal analgesia after TKA.

Omega-3 Therapy is Not Associated with Reduced Gastrointestinal Bleeding in HeartMate 3 Left Ventricular Assist Device Patients

<h3>Purpose</h3> Previous studies showed that prophylactic administration of omega-3 was associated with increased freedom from gastrointestinal bleeding (GIB) in a cohort of patients receiving Heartmate II and HVAD devices. This study aims to assess whether reduction in GIB incidence can be achieved with omega-3 therapy in patients implanted with the newer Heartmate III LVAD. <h3>Methods</h3> We retrospectively analyzed 75 patients implanted with a Heartmate III LVAD at a large tertiary academic medical center between August 2013 and March 2020. 23 patients (56.2 ± 13.4 years old and 69.6% male) received omega-3 therapy at 2.4 ± 1.2 g/day, while 52 patients in the control group (55.0 ± 13.0 years old and 69.2% male) did not receive any omega-3 therapy. <h3>Results</h3> Incidence of GIB at 1 year was not significantly different in the omega-3 group as compared with the control group (25.0% versus 30.4%, P=0.836). Omega-3 therapy was not associated with the occurrence of GIB at 1 year (HR, 1.375; 95% CI, 0.520-3.636; P=0.520). No significant difference was observed when patients were further stratified into dosage groups of those receiving 1, 2, or 4 g/day of omega-3. <h3>Conclusion</h3> In this single center retrospective study, omega-3 therapy was not associated with a lower rate of GIB in patients implanted with the newer Heartmate III LVAD consistent with previously reported findings that this cohort of patients experiences fewer hemocompatibility related adverse events overall at baseline. Future studies are warranted to better understand whether innate technological advances of Heartmate III operate through the same mechanisms as omega-3 therapy to confer similar but non-additive effects on the incidence of GIB.

Renal safety evaluation of aspirin plus edaravone in patients with ischaemic stroke: a retrospective cohort study

Background and objectiveAspirin combined with edaravone is more effective than aspirin or edaravone alone in the treatment of ischaemic stroke. Aspirin is defined as a nephrotoxic drug while the renal...

703 Evaluation of a Stress Ulcer Prophylaxis Protocol in an Burn Intensive Care Unit

IntroductionPatients suffering from large burn injuries have an increased risk of gastrointestinal mucosal damage from stress ulcers. Proton pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs) are routinely used for stress ulcer prophylaxis in burn patients, however there are few comparative trials evaluating the efficacy of these therapies in the burn population. Our burn center uses a stress ulcer prophylaxis protocol that incorporates both classes in a step-wise manner. The objective of this study was to evaluate the protocol by comparing the incidence of uncontrolled gastric pH, positive gastric occult blood, and gastrointestinal bleed (GIB) while on famotidine or pantoprazole prophylaxis.MethodsThis was a single-center retrospective observational study conducted at an academic medical center and was approved by the hospital’s Institutional Review Board. Patients were included if they were at least 18 years of age, admitted to the burn intensive care unit (BICU) from June 2017 to August 2020 with burns involving at least 1% TBSA, and had at least one documented gastric pH and/or occult blood test while receiving famotidine or pantoprazole. The primary endpoint was a composite of gastric pH less than 5, a positive occult blood test, or occurrence of GIB.ResultsIn total, 107 patients with a mean age of 55 yo were included in the study. The median TBSA burn was 16% and length of stay was 23 days. Seventy seven (72%) patients received famotidine and 93 (87%) of patients received pantoprazole. The incidence of the primary endpoint in all patients receiving famotidine and pantoprazole were 69 (90%) and 86 (92%), respectively (p = 0.513). During famotidine prophylaxis, 256 (43%) gastric pH tests were less than 5 and 397 (47%) gastric occult blood tests were positive, with no reports of GI bleeding. During pantoprazole prophylaxis, 751 (33%) gastric pH tests were less than 5 and 1220 (47%) gastric occult blood tests were positive, and 4 (4%) were diagnosed with a GI bleed. A total of 91 (85%) patients had deviations from the protocol, which included 42 (46%) patients who did not receive the recommended dose or agent, 27 (30%) patients who were not initiated on the recommended initial agent, and 22 (24%) patients who did not receive a recommended increase in dose or switch agents when recommended.ConclusionsIn the setting of burn injuries of at least 1% TBSA, no difference was detected in uncontrolled gastric pH, positive occult blood tests, or GIB when using famotidine or pantoprazole in our stress ulcer prophylaxis protocol. The overall incidence of gastric pH less than 5 and positive gastric occult blood was high for both agents, while the incidence of GIB was low in both groups.

Effects of Substance Use Disorder on In-Hospital Outcomes of Young Patients Presenting With a Cardiovascular Event: A Nationwide Analysis.

BackgroundSubstance use is widely prevalent among young adults and is associated with increased cardiovascular morbidity and mortality such as sudden cardiac arrest, acute coronary syndrome, arrhythmias, and cardiomyopathy. However, they are limited studies analyzing the impact of substance use disorder on in-hospital outcomes among young patients with cardiovascular events.MethodsAll patients aged 18-39 years admitted primarily for major cardiovascular events including acute myocardial infarction (AMI), arrhythmia, cardiac arrest, acute ischemic stroke, and venous thromboembolic events in 2019 were identified in the National Inpatient Sample database. They were then categorized into those with and without concomitant substance use disorder (SUD). The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest.ResultsOf 57,985 hospitalizations with cardiac events, 12,115 (20%) of young adults had concomitant SUD. SUD was significantly associated with cardiac arrest (OR 3.3; CI 2.4-4.4), atrial fibrillation (OR 1.5; CI 1.3-1.7), AMI (OR 1.3; CI 1.2-1.6), heart failure (OR 2.6; CI 2.4-3.0) (all p<0.05) despite a lower prevalence of traditional cardiovascular risk factors than non-users. Logistic regression showed acute kidney injury (aOR 1.5; CI 1.3-1.8; p<0.001) and inpatient mortality (aOR 1.6; CI 1.2-2.2; p<0.001) were also significantly higher in young patients presenting with cardiac events and concomitant SUD. There was no difference in the length of stay or incidence of gastrointestinal bleed between the two groups.ConclusionIn young patients presenting with a cardiovascular event, concurrent substance use disorder was associated with increased in-hospital mortality despite significantly lower comorbidities.