Incidence Of GI Bleeding Research Articles

Risk of post-sphincterotomy bleeding with antiplatelet and anticoagulant use: a propensity-matched analysis of the U.S. Collaborative Network.

GI bleeding after ERCP is a serious adverse event and most commonly occurs after endoscopic biliary and/or pancreatic sphincterotomy. Although the strength of available evidence for post-sphincterotomy GI bleeding risk is high for therapeutic warfarin and heparin, it remains unknown for antiplatelet agents like clopidogrel and prasugrel. We conducted a retrospective United States-based, propensity-matched cohort study to assess the risk of post-sphincterotomy bleeding in patients receiving anticoagulant (AC) and antiplatelet (APT) therapy. We analyzed the U.S. Collaborative Network in the TriNetX platform through December 27, 2022, to include patients receiving APT and AC therapy who underwent ERCP within 7 days of hospitalization. One-to-one propensity score matching was performed. The primary outcome was the incidence of GI bleeding within 7 days of sphincterotomy. Secondary outcomes included need for blood transfusion, intensive care unit care, and all-cause mortality within 30 days of bleeding. Overall, 2806 patients (1806 in the AC cohort and 1000 in the APT cohort) underwent ERCP with sphincterotomy. One-to-one propensity score matching was performed for age, body mass index≥30 kg/m2, gender, race, ethnicity, diabetes mellitus, nicotine dependence, presence and severity of chronic kidney disease, cirrhosis, and thrombocytopenia between the cohorts. Patients in both cohorts had an increased risk of post-sphincterotomy bleeding compared with matched control subjects (adjusted odds ratios of 3.6 [95% confidence interval, 2.58-5.06] and 2.2 [95% confidence interval, 1.43-3.56], respectively). Although heparin bridging therapy and concurrent use of aspirin did not further increase the risk of GI bleeding, resumption of AC within 24 hours' postprocedure did. Neither cohort of patients was at an increased risk for blood transfusion, intensive care unit care, or all-cause mortality. Our database analysis shows that patients receiving AC and APT therapy are at a higher risk of post-sphincterotomy bleeding compared with matched control subjects. An appropriate drug cessation period or alternative biliary decompression modalities may be used in these patients.

The effectiveness and cost of lansoprazole and pantoprazole for stress ulcer prophylaxis in intensive care unit

The incidence of bleeding is increased in high risk patients with critical conditions in Intensive Care Unit (ICU). Appropriate prophylaxis medicine is necessary to reduce the incidence of stress ulcer bleeding during hospitalization in ICU which further can minimize the cost of patient care in the ICU. Currently, lansoprazole and pantoprazole are used as a stress ulcers prophylaxis. Nevertheless, there has not been sufficient evidence proving their effectiveness. This study was aimed to compare the effectiveness and cost between iv lansoprazole and iv pantoprazole as a stress ulcer prophylaxis in ICU. In this retrospective observational study, the data were obtained from medical records of all patients admitted to ICU in a District Hospital in Yogyakarta from January 2014 until December 2016. Effectiveness of therapy were obtained from objective data in the medical record by looking at the incidence of major (clinically significant) and minor (overt gastrointestinal) bleeding. Chi-square analysis was performed to analyze the difference of bleeding incidence. The average cost was presented as Expected Monetary Value (EMV), which consisted of the cost of prophylaxis and treatment of bleeding. The difference in average cost was analyzed using independent t-test. A total of 119 patients were included in this study. There were 62 patients in the lansoprazole group and 47 patients in the pantoprazole group. Forty eight patients (77,4%) from lansoprazole group and 35 patients (61,4%) from pantoprazole group did not experience any GI bleeding. There was no statistical difference in the incidence of GI bleeding between the two groups (CI 95%, P-value = 0.057). The EMV of lansoprazole group was higher than pantoprazole group IDR 645.122,57 and IDR 511.629,39 respectively. In conclusion, there was no significant difference regarding the effectiveness between iv lansoprazole and iv pantoprazole as stress ulcer prophylaxis. Costs for the prophylaxis of stress ulcers is lower on the use of pantoprazole compared to lansoprazole.

A Comparison of the Rates of Gastrointestinal Bleeding and Mortality in Cirrhotic Patients with Coronary Artery Disease Treated with Cardiac Stents vs Medical Management

Introduction: The reported prevalence of coronary artery disease (CAD) in patients with cirrhosis is as high as 28%. Since cirrhotic patients are at risk for GI bleeding (GIB) due to varices and coagulopathy, it is not clear if the benefits of treating their CAD with coronary stents outweigh the risks of GIB from the dual antiplatelet therapy (DAPT) required to prevent stent thrombosis. To address this issue, we assessed the rates of mortality and GIB in cirrhotic patients whose CAD was treated with cardiac stenting or with medical management.Table 1Table 2Methods: We conducted a retrospective review of medical records to identify all patients with: 1) CAD diagnosed by coronary angiography or stress test, and 2) cirrhosis diagnosed clinically or radiographically between January 2000 and September 2015. Patients were divided into two groups based on CAD treatment (stent or medical), and outcomes were compared between groups. Primary outcomes studied were rates of GIB (evaluated at 30 days, 90 days, 1 year, and 2 years) and mortality (evaluated at 30 days, 90 days, and 1 year). Results: We identified 148 patients with both CAD and cirrhosis (mean age 60.4 ± 0.6 years, 98% men); 68 had coronary stent implantation (cases) and 80 were managed medically (controls). Cases and controls did not differ significantly in basic demographics, Charlson Comorbidity Index, MELD scores, or indication for cardiac work-up (see table); the frequency of hyperlipidemia and prior myocardial infarction were significantly higher in cases, and the frequency of combined hepatitis C and alcohol was higher in controls. DAPT was used for ≥ 30 days in 99% of cases, and in only 5% of controls. The incidence of GIB was 7.4% vs. 1.3% at 30days (p=0.09), 10.3% vs. 2.5% at 90days (p=0.08), 22.1% vs. 5% at 1year (p=0.003) and 27.9% vs. 5% at 2 year (p=0.0002). Interestingly, there was no significant difference between the groups in mortality at any time point (cases vs. controls: 2.9% vs. 1.3% at 30 days, 2.9% vs. 3.8% at 90 days, and 11.8% vs. 13.8% at 1 year). Moreover, rates of GIB were similar among patients who received DES and BMS (26.9% vs. 31.3%, p=0.76). Conclusion: For our patients who had both cirrhosis and CAD, those treated with coronary stents had a significantly higher rate of GIB, but no significantly different rate of mortality, than those whose CAD was treated medically. This information is useful when determining the risk/benefit ratio of PCI among patients with cirrhosis.

Gastrointestinal Bleeding After Craniotomy: A Retrospective Review of 518 Patients

A retrospective review of the medical records of 518 patients who underwent craniotomy over a 3 year interval was carried out to determine the rate of gastrointestinal bleeding and its relationship to the Glasgow Coma Score. There were 288 [55.5%] males and 230 [44.5%] females in the series; the mean age was 51.5 +/- 18.9 years. Forty percent had brain tumours, 18% had subarachnoid hemorrhage, 14% had spontaneous intracerebral hemorrhage, 19% had head injury and 8% had other diagnoses. Forty-eight [9.3%] of the patients had significant gastrointestinal bleeding, the distribution of which was as follows: hematemesis [37/518], melena [11/518] and/or hematochezia [4/518]. A further 51 [9.8%] had evidence of "coffee ground emesis" only. Of those with a Glasgow Coma Score of less than 10, 21% had significant GI bleeding while only 7% of patients with a Glasgow Coma Score greater than 10 had such a bleed [p less than 0.005]. Further analysis showed that the incidence of GI bleeding in patients who underwent craniotomy increased with decreasing GCS. GI bleeding did not correlate with age, sex, steroid administration or casual use of anti-ulcer medication.