Incidence Of Rebleeding In Patients Research Articles

Construction of a prediction model for rebleeding in patients with acute upper gastrointestinal bleeding

BackgroundThe incidence of rebleeding in patients with upper gastrointestinal bleeding (UGIB) remains despite advances in intervention approaches. Therefore, early prediction of the risk of rebleeding could help to greatly reduce the mortality rate in these patients. We aim to develop and validate a new prediction model to predict the probability of rebleeding in patients with AUGIB.MethodsA total of 1170 AUGIB patients who completed the procedure of emergency gastroscopy within 48 h of admission were included. Logistic regression analyses were performed to construct a new prediction model. A receiver operating characteristic curve, a line graph, and a calibration and decision curve were used to assess the predictive performance of our new prediction model and compare its performance with that of the AIMS65 scoring system to determine the predictive value of our prediction model.ResultsA new prediction model was constructed based on Lactic acid (LAC), neutrophil percentage (NEUTP), platelet (PLT), albumin (ALB), and D-DIMER. The AUC values and their 95% confidence interval (CI) for the new prediction model and the AIMS65 score were 0.746 and 0.619, respectively, and 0.697–0.795 and 0.567–0.670, respectively. In the training group, the C index values based on the prediction model and the AIMS65 scoring system were 0.720 and 0.610, respectively. In the validation group, the C index values based on the prediction model and the AIMS65 scoring system were 0.828 and 0.667, respectively. The decision and calibration curve analysis also showed that the prediction model was superior to the AIMS65 scoring system in terms of accuracy of prediction, consistency, and net clinical benefit.ConclusionThe prediction model can predict the probability of rebleeding in AUGIB patients after endoscopic hemostasis therapy.

Comparison of outcomes in patients at high risk for recurrent gastroesophageal variceal bleeding treated by endoscopic ultrasound-guided cyanoacrylate injection for secondary prophylaxis or conventional endoscopic cyanoacrylate injection for index bleeding alone

Background and Objectives:Patients with hepatocellular carcinoma (HCC) or other malignancies with portal vein thrombosis (PVT) are at high risk for recurrent variceal bleeding. Recent evidence suggested that secondary prophylaxis (SP) for variceal bleeding may improve clinical outcomes.Methods:From 2014 to 2016, consecutive patients with HCC ± PVT or non-HCC malignancy + PVT with gastroesophageal variceal bleeding within 12 weeks were recruited for endoscopic ultrasound-guided cyanoacrylate injection (EUS-CYA) for SP. Varices = 3 mm on EUS were treated by EUS-CYA. Patients were followed up for 6 months after EUS or till death. A historical control group of HCC patients who underwent esophagogastroduodenoscopy-CYA (EGD-CYA) for index gastroesophageal variceal bleeding alone was identified in a prospective gastrointestinal bleed database from 2009 to 2013 for comparison.Results:Twenty-three patients underwent EUS-CYA for SP, while 33 HCC patients who underwent EGD-CYA for index variceal bleeding alone were identified as historical controls. In the EUS-CYA group, twenty patients had HCC + cirrhosis (85.0% also with PVT), while the other three patients had non-HCC malignancy + PVT. Majority of the HCC patients in both groups had Barcelona clinic liver cancer Stage C disease (85.0% vs. 75.8%, P = 0.421) and Child-Pugh Class B cirrhosis (55.0% vs. 71.4%, P = 0.241). Both the 30- and 90-day death adjusted cumulative incidence of rebleeding was significantly lower in the EUS-CYA group when compared to EGD-CYA control group (13% vs. 42% at 30-day, P = 0.023 and 22% vs. 61% at 90-day, P = 0.005, respectively).Conclusion:EUS-CYA for SP significantly reduces both the 30-day and 90-day death adjusted cumulative incidence of rebleeding in patients at high risk for recurrent gastroesophageal variceal bleeding when compared to EGD-CYA for index bleeding alone.

Risk Factors Associated with Rebleeding in Patients with High Risk Peptic Ulcer Bleeding: Focusing on the Role of Second Look Endoscopy.

Re-bleeding after initial hemostasis in peptic ulcer bleeding can be life threatening. Identification of factors associated with re-bleeding is important. The aims of this study were to determine incidence of rebleeding in patients with high risk peptic ulcer bleeding and to evaluate factors associated with rebleeding. Among patients diagnosed as upper gastrointestinal hemorrhage at seven hospitals in Daegu-Gyeongbuk, and one hospital in Gyeongnam, South Korea, from Feb 2011 to Dec 2013, 699 patients diagnosed as high risk peptic ulcer bleeding with Forrest classification above llb were included. The data were obtained in a prospective manner. Among 699 patients, re-bleeding occurred in 64 (9.2 %) patients. Second look endoscopy was significantly more performed in the non-rebleeding group than the rebleeding group (81.8 vs 62.5 %, p < 0.001). In multivariate analysis, use of non-steroidal anti-inflammatory agents, larger transfusion volume (≥5 units), and non-performance of second look endoscopy were found as risk factors for rebleeding in high risk peptic ulcer bleeding. In our study, rebleeding was observed in 9.2 % of patients with high risk peptic ulcer bleeding. Performance of second look endoscopy seems to lower the risk of rebleeding in high risk peptic ulcer bleeding patients and caution should be paid to patients receiving high volume transfusion and on medication with NSAIDs.

Aminocaproic Acid Prophylaxis in Traumatic Hyphema

Oral aminocaproic acid has been shown to be effective in clot stabilization and in the reduction of secondary bleeding rates in cases of traumatic hyphema. In a retrospective study of 105 patients treated during a 1-year period, we found the incidence of rebleeding in patients with traumatic hyphema who received aminocaproic acid prophylaxis was 2%; the incidence in those who did not was 25%.

Forrest 11 bleeding: indications for treatment and results of laser therapy.

Ulcers with stigmata of recent hemorrhage (SRH) but without evidence of active bleeding (Forrest 11 bleeding) are a common endoscopic finding in patients with upper gastrointestinal bleeding. This study considers the problem of identifying patients in this group at risk of further bleeding and death. The high incidence of rebleeding in patients with visible vessel and the low incidence in patients with other SRH or no SRH suggest that endoscopic therapy in the absence of active bleeding is best limited to patients with visible vessels in ulcers that have recently bled. Evidence from controlled trials of laser therapy is presented which suggests that laser therapy can reduce the incidence of rebleeding in such patients with visible vessel.

Source of fibrin/fibrinogen degradation products in the CSF after subarachnoid hemorrhage

In 48 patients with a subarachnoid hemorrhage, levels of fibrin/fibrinogen degradation products (FDP's), total protein, and plasminogen were measured in the cerebrospinal fluid (CSF) between Days 9 and 15 after the bleed. Of these 48 patients, 22 received tranexamic acid. Despite a significant reduction in the incidence of rebleeding in patients taking tranexamic acid, no difference in FDP levels was found between patients receiving tranexamic acid and a control group of patients who were not; nor was any relationship evident between FDP levels and rebleeding. In patients with detectable levels of FDP's, CSF protein and plasminogen values were also increased, and FDP's were found more frequently in the CSF of patients with an impaired level of consciousness or with a neurological deficit. These findings suggest that in the 2nd week after subarachnoid hemorrhage, the presence of FDP's in the CSF reflects a damaged blood-CSF barrier rather than ongoing local fibrinolysis in the subarachnoid space. A finding of FDP's in the CSF is, therefore, an unreliable monitor of antifibrinolytic treatment in subarachnoid hemorrhage and cannot be used for selecting patients at high risk of rebleeding.

Transhepatic portal venous embolization of varices: pros and cons.

Transhepatic portal venous embolization does not reduce immediate or long-term mortality or the incidence of rebleeding in patients with acute hemorrhage from gastroesophageal varices. Since in addition the procedure is not without risk to the operator, who is exposed to a considerable amount of radiation, the author recommends conservative treatment of acute variceal hemorrhage. Transhepatic portal venous embolization should be used only in patients in whom endoscopic sclerosis has failed and in whom there is reason to believe a selective splenorenal shunt can be successful.

Aminocaproic Acid in the Treatment of Traumatic Hyphema

Of 59 patients with traumatic hyphema studied prospectively, 32 received aminocaproic acid, an antifibrinolytic agent, to prevent secondary hemorrhage. The remaining 27 patients received placebo in an identical manner. Of the aminocaproic acid-treated patients, only one (3%) rebled, while nine patients (33%) receiving placebo suffered secondary hemorrhage. The results of this study indicate a statistically significant reduction (P less than .01) in the incidence of rebleeding in patients treated with this drug.