Odds Of Bleeding Research Articles

Periodontal health in a large cohort of Ugandans living with HIV: a cross-sectional study

BackgroundThe impact of periodontitis on large populations of people living with HIV (PLHIV) in resource-constrained settings remains largely un-investigated. This study aims to address this knowledge gap by providing a comprehensive description of the periodontal health status among a sizable cohort of Ugandans living with HIV.MethodsThis was a cross-sectional study with 4,449 participants who were over 18-years old with data captured on their reported age, gender, tobacco use, length of time on HAART and alcohol use. Periodontal health was assessed using the WHO periodontal probe and the modified CPI data entry form. Descriptive statistics were reported using frequencies for the affected number of sextants in the surveyed participants. This was followed by additional regression analysis using the R statistical computing environment, with the periodontal health outcomes (bleeding on probing, pocket depth and clinical attachment loss) individually as the dependent, recorded as binary outcomes. A multilevel model was run with clinical attachment loss as the dependant variable controlling for all the other factors. The 95% confidence intervals were used to report the level of significance for each test.ResultsThere were 3,103/4,449 (69.7%) female participants. The mean age was 44.3 years (SD 10.1 years) with a range of 18 to 89 years. About 66% of the participants had bleeding on probing at one or more of the examined sites/tooth surfaces. The odds for bleeding on probing were significantly higher for female participants (adjusted Odds ratio: 1.49, 95% CI 1.19 to 1.86), and higher in individuals who reported tobacco use (adjusted odds ratio 1.62, 95% CI 1.09 to 2.41). Slightly under half of our participants (48.2%) had moderate to severe clinical attachment loss.ConclusionsThis study found that among Ugandans living with HIV, periodontal disease is a significant public health concern. The majority of study participants had bleeding on probing and almost half of them recording moderate to severe clinical attachment loss, worsened by age and time on HAART. This highlights the need for comprehensive oral health care and targeted interventions for this population.

Periodontal health in a large cohort of Ugandansliving with HIV: A cross-sectional study.

The impact of periodontitis on large populations of people living with HIV (PLHIV) in resource-constrained settings remains largely un-investigated. This study aims to address this knowledge gap by providing a comprehensive description of the periodontal health status among a sizable cohort of Ugandans living with HIV. This was a cross-sectional study with 4,449 participants who were over 18-years old and captured their reported age, gender, tobacco use, length of time on HAART and alcohol use. Periodontal health was assessed using the WHO periodontal probe and the modified CPI data entry form. Descriptive statistics were reported using frequencies for the affected number of sextants in the surveyed participants. This was followed by additional regression analysis using the R statistical computing environment, with the periodontal health outcomes (bleeding on probing, pocket depth and clinical attachment loss) individually as the dependant, recoded as binary outcomes. A multilevel model was run with clinical attachment loss as the dependant variable controlling for all the other factors. The 95% confidence intervals were used to report the level of significance for each test. There were 3,103/4,449 (69.7%) female participants. The mean age was 44.3 years (SD 10.1 years) with a range of 18 to 89 years. About 66% of the participants had bleeding on probing at one or more of the examined sites/tooth surfaces. The odds for bleeding on probing were significantly higher for female participants (adjusted Odds ratio: 1.49, 95% CI 1.19 to 1.86), and higher in individuals who reported tobacco use (adjusted odds ratio 1.62, 95% CI 1.09 to 2.41). Slightly under half of our participants (48.2%) had moderate to severe clinical attachment loss. This study found that among Ugandans living with HIV, periodontal disease is a significant public health concern. The majority (66%) had bleeding on probing, with a sizeable number (48.2%) of participants recording moderate to severe clinical attachment loss, worsened by age and time on HAART. This highlight the need for comprehensive oral health care and targeted interventions for this population.

Endoscopic ultrasound-guided lumen-apposing metal stent with or without coaxial plastic stent for pancreatic fluid collections: a systematic review and meta-analysis comparing safety and efficacy.

Endoscopic ultrasound (EUS)-guided lumen-apposing metal stents (LAMS) are preferred for draining symptomatic large pancreatic fluid collections (PFCs). A concurrent coaxial double-pigtail plastic stent (DPPS) is proposed to reduce adverse events associated with LAMS. We aimed to perform a comparative outcome analysis of LAMS with or without DPPS for PFCs. Electronic databases from January 2005 through July 2023 were searched for studies comparing the use of LAMS with or without DPPS for PFCs. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models. After reviewing 1780 studies, we extracted data from 6 studies comprising 348 patients. The weighted odds of overall technical success, using LAMS plus DPPS compared to LAMS alone, were 0.53 (95% confidence interval [CI] 0.15-1.83), and the odds of clinical success were 1.10 (95%CI 0.59-2.05). The weighted odds of total adverse events with LAMS compared to LAMS plus DPPS were 2.21 (95%CI 1.37-3.59). Analysis of individual adverse events showed that the odds of stent occlusion when LAMS alone was used compared to LAMS plus DPPS was 2.36 (95%CI 1.12-4.98). The odds of bleeding were 1.84 (95%CI 0.77-4.38), and the odds of stent migration 0.95 (95%CI 0.40-2.23). EUS-guided LAMS placement is the current standard of care for managing symptomatic large PFCs. Concurrent use of coaxial DPPS can mitigate the overall adverse events observed with LAMS, while maintaining similar technical and clinical success.

Ethnicity in Complex High-Risk but Indicated Percutaneous Coronary Intervention Types and Outcomes

Complex High-risk but indicated Percutaneous coronary interventions (CHiPs) is increasingly common in contemporary practice. However, data on ethnic differences in CHiP types, outcomes, and trends in patients with stable angina are limited; this is pertinent given the population of Black, Asian, and other ethnic minorities (BAME) in Europe is increasing. We conducted a retrospective analysis of CHiP procedures undertaken in patients with stable angina using data obtained from the BCIS (British Cardiovascular Intervention Society) registry (2006 to 2017). CHiP cases were identified and categorized by ethnicity into White and BAME groups. We then performed multivariable regression analysis and propensity score matching to determine adjusted odds ratios (aORs) of in-hospital mortality, major bleeding, and major adverse cardiovascular and cerebral events (MACCEs) in BAME compared with Whites. Of 424,290 procedure records, 105,949 were CHiP (25.0%) (White 89,038 [84%], BAME 16,911 [16%]). BAME patients were younger (median 68.1 vs 70.6 years). Previous coronary artery bypass surgery (33.4% vs 38.3%), followed by chronic total occlusion percutaneous coronary intervention (31.9% vs 32%) were common CHiP variables in both groups. The third common variable was age 80 years and above (23.6%) in White patients and severe vascular calcifications in BAME patients (18.8%). BAME patients had higher rates of diabetes (41.1 vs 23.6%), hypertension (68 vs 66.5%), previous percutaneous coronary intervention (43.7 vs 37.6%), and previous myocardial infarction (44.9 vs 42.5%), (p <0.001 for all). Mortality (aOR 1.1, 95% confidence interval [CI] 0.8 to 1.5) and MACCE (aOR 1.0, 95% CI 0.8 to 1.1) odds were similar among the groups. Bleeding odds (aOR 0.7, 95% CI 0.6 to 0.9) were lower in BAME. In conclusion, CHiP procedures differed among the ethnic groups. BAME patients were younger and had worse cardiometabolic profiles. Similar odds of death and MACCE were seen in BAME compared with their White counterparts. Bleeding odds were 30% lower in the BAME group.

Prediction Factors of Early Postoperative Bleeding after Bariatric Surgery.

Identifying the possible predictors of postoperative bleeding is advantageous to reduce healthcare costs and promote patients' recovery. The aim of this study was to determine early postoperative bleeding predictors after bariatric surgery. This retrospective study was conducted using data from 2260 patients who underwent bariatric surgery. We diagnosed early postoperative bleeding by the following symptoms: abdominal pain, hypotension, tachycardia, hematemesis, melena, decreased hemoglobin level, the need for at least two units of packed red blood cells (PRBCs) transfusion, and reoperation within the first 48h after surgery. Our results showed the odds of early postoperative bleeding in laparoscopic Roux-en-Y gastric bypass (LRYGB) were higher than in laparoscopic sleeve gastrectomy (LSG) (OR 3.49, 95% CI 1.79 to 6.80). In addition, prior intragastric balloon (IGB) (OR 3.14, 95% CI 1.18 to 8.34) and oral non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) (OR 5.91, 95% CI 1.79 to 20.63) were positively associated with the occurrence of postoperative bleeding. In contrast, there was an inverse relationship between staple line oversewing and the odds of postoperative bleeding (OR 0.18, 95% CI 0.04 to 0.81). After stratification data based on the type of the surgery, the positive association between IGB and the odds of bleeding was constant in the LRYGB group. In the LSG group, use of non-aspirin NSAIDs was linked to a higher incidence of postoperative bleeding, while oversewing of the staple line lowered the incidence of this event. Our results demonstrated a positive association between type of procedure, history of IGB, and oral non-aspirin NSIADs use, as well as an inverse relationship between staple line oversewing and the odds of bleeding after bariatric surgery.

A213 ERCP-RELATED ADVERSE EVENTS IN PRIMARY SCLEROSING CHOLANGITIS: A SYSTEMATIC REVIEW &amp; META-ANALYSIS

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool in primary sclerosing cholangitis (PSC). Although the complications of ERCP are well known in the general population, there is conflicting data regarding complications in patients with PSC. Factors that predict ERCP-related adverse events in PSC are also unclear.AimsTo conduct a systematic review and meta-analyses to 1. compare ERCP-related adverse events in patients with and without PSC and 2. determine risk factors associated with ERCP-related adverse events in PSC.MethodsA systematic search was conducted in Embase, PubMed and CENTRAL for studies published from January 1, 2000 to May 12, 2021. Eligible studies included adults with PSC undergoing ERCP and reported at least one ERCP-related adverse event (bleeding, perforation, pancreatitis, cholangitis) or risk factor associated with complications. Raw event rates for adverse events and risk factors were used to calculate odds ratios (ORs) which were then pooled using random-effects models.ResultsFour studies contributed to the first meta-analysis. There was a significant three-fold increase in the 30-day odds of cholangitis in PSC compared to those without PSC (4.3% vs. 2.0%; OR 3.26, 95% CI 1.08–9.90; p=0.037; I2=73.0%) (Figure 1). However, there were no significant differences in 30-day pancreatitis (4.2% vs. 3.4%; OR 0.89, 95% CI 0.26–3.07; p=0.851; I2=87.9%), bleeding (0.3% vs. 1.1%; OR 0.36, 95% CI 0.06–2.21; p=0.272; I2=50.3%), or perforation (0.7% vs. 0.5%; OR 1.19, 95% CI 0.40–3.51; p=0.752; I2=28.5%).In a second meta-analysis, risk factors contributing to post-ERCP pancreatitis (PEP) in PSC were pooled from five studies. While female sex was not associated with PEP, accidental passage of wire into the pancreatic duct (OR 7.44, 95% CI 3.33–16.65; p<0.001; I2=65.0%) and biliary sphincterotomy (OR 4.80, 95% CI 1.92–12.03; p=0.001; I2=73.1%) were associated with higher PEP odds.ConclusionsIn the context of limited comparative data and study heterogeneity, PSC patients have higher odds of post-ERCP cholangitis despite the majority receiving antibiotics. Odds of bleeding, pancreatitis, and perforation were similar between groups. Accidental wire passage and biliary sphincterotomy increased odds of PEP, which helps identify higher-risk groups. Future studies should elucidate ERCP-related risks in PSC and guide preventive strategies. Figure 1: 30-Day ERCP ComplicationsFunding AgenciesNone

Risk Factors Associated With Bleeding in Children With Cardiac Disease Receiving Extracorporeal Membrane Oxygenation: A Multi-Center Data Linkage Analysis.

Background: Bleeding is a common complication of extracorporeal membrane oxygenation (ECMO) for pediatric cardiac patients. We aimed to identify anticoagulation practices, cardiac diagnoses, and surgical variables associated with bleeding during pediatric cardiac ECMO by combining two established databases, the Collaborative Pediatric Critical Care Research Network (CPCCRN) Bleeding and Thrombosis in ECMO (BATE) and the Extracorporeal Life Support Organization (ELSO) Registry.Methods: All children (<19 years) with a primary cardiac diagnosis managed on ECMO included in BATE from six centers were analyzed. ELSO Registry criteria for bleeding events included pulmonary or intracranial bleeding, or red blood cell transfusion >80 ml/kg on any ECMO day. Bleeding odds were assessed on ECMO Day 1 and from ECMO Day 2 onwards with multivariable logistic regression.Results: There were 187 children with 114 (61%) bleeding events in the study cohort. Biventricular congenital heart disease (94/187, 50%) and cardiac medical diagnoses (75/187, 40%) were most common, and 48 (26%) patients were cannulated directly from cardiopulmonary bypass (CPB). Bleeding events were not associated with achieving pre-specified therapeutic ranges of activated clotting time (ACT) or platelet levels. In multivariable analysis, elevated INR and fibrinogen were associated with bleeding events (OR 1.1, CI 1.0–1.3, p = 0.02; OR 0.77, CI 0.6–0.9, p = 0.004). Bleeding events were also associated with clinical site (OR 4.8, CI 2.0–11.1, p < 0.001) and central cannulation (OR 1.75, CI 1.0–3.1, p = 0.05) but not with cardiac diagnosis, surgical complexity, or cannulation from CPB. Bleeding odds on ECMO day 1 were increased in patients with central cannulation (OR 2.82, 95% CI 1.15–7.08, p = 0.023) and those cannulated directly from CPB (OR 3.32, 95% CI 1.02–11.61, p = 0.047).Conclusions: Bleeding events in children with cardiac diagnoses supported on ECMO were associated with central cannulation strategy and coagulopathy, but were not modulated by achieving pre-specified therapeutic ranges of monitoring assays.

Abstract 13601: Cardiovascular Outcomes of Transradial versus Transfemoral Percutaneous Coronary Intervention in End Stage Renal Disease. A Meta Regression Analysis

Introduction: Limited data is available on comparison of outcomes among transradial (TR) and transfemoral (TF) access of percutaneous coronary intervention (PCI) in End Stage Renal Disease (ESRD). Hypothesis: Which access route is better for better cardiovascular outcomes or lower procedural complications among ESRD patients. Methods: Online databases including MEDLINE and Cochrane Central were queried to compare cardiovascular outcomes among TR and TF in ESRD patients. The primary outcome of this meta-analysis was to compare the bleeding complications and in-hospital mortality difference between TR PI and TF PCI in patients with ESRD. The secondary outcomes included differences in Mortality, Cardiovascular accident (CVA), Myocardial infarction (MI), Bleeding, Transfusion, Cardiogenic shock, and Heart failure. Unadjusted odds ratios (OR) were calculated using a random effect model with a 95% confidence interval (CI) and P &lt;0.05 as a statistical significance. Results: A total of 5 studies including 7383 patients ( TR-PCI = 1208 ; TF-PCI = 6275) were included in this analysis. The overall mean age was 70 years; while the mean for TR-PCI and TF-PCI was 71 years and 69.1 years respectively. TR-PCI was associated with lower odds of bleeding (OR 0.48 95% CI 0.33, 0.69, p&lt;0.05, I2 0.00%) (Figure 1A), transfusion requirement (OR 0.52 95% CI 0.40, 0.68, p&lt;0.05, I2 0.00%), and mortality (OR 0.41 95% CI 0.26, 0.66, p&lt;0.05, I2 0.00%) (Figure 1B). We did not find any statistically significant difference in CVA (OR 1.06 95% CI 0.37, 3.00 p&gt;0.05, I2 0.00%), MI (OR 0.97 95% CI 0.57, 1.63, p&gt;0.05, I2 0.00%), CS (OR 0.53 95% CI 0.06, 4.42, p&gt;0.05, I2 48.48%) between TR and TF PCI in ESRD population. We didn’t find any effect modifier in our study on regression analysis. Conclusions: TR access is associated with better cardiovascular outcomes as compared to TF access PCI in ESRD patients with any coronary artery disease.

Direct oral anticoagulants compared with vitamin K antagonists for left ventricular thrombi systematic review and meta-analysis

Abstract Background Left ventricular thrombus (LVT) is a serious complication primarily occurring in patients with LV dysfunction following large myocardial infarction. The role of direct oral anticoagulants in this clinical setting remains controversial. Purpose To compare DOACs versus vitamin K antagonists (VKA) in LVT treatment. Methods We systematically searched PubMed, Embase and Cochrane databases, in February 2020, for interventional or observational studies comparing DOAC with VKA on LVT treatment. Results Fourteen publications were included, nine published studies and five conference abstracts, providing 1899 patients, 490 patients on DOACs and 1409 subjects on VKA. In terms of efficacy, DOAC had a lower LVT resolution for all studies included which reported LVT resolution (pooled OR, 0.73; 95% CI, 0.55–0.98; P=0.04; I2=52%), but sensitivity analysis revealed no difference between anticoagulant strategy (pooled OR, 0.78; 95% CI, 0.57–1.05; P=0.10; I2=59%). In terms of systemic embolism or stroke, DOAC had a similar efficacy (pooled OR, 1.06; 95% CI, 0.69–1.63; P=0.78; I2=30%) compared to VKA. In clinically relevant bleeding events analysis, the anticoagulation strategy did not differ in the odds of bleeding (pooled OR, 0.65; 95% CI, 0.37–1.15 P=0.14; I2=0%), with similar findings in net adverse clinical events analysis (pooled OR, 0.66; 95% CI, 0.35–1.25; I2=54%; P=0.20). Conclusion Our pooled data suggests DOACs as a safe approach to LVT, despite inconsistent efficacy on LVT resolution. Funding Acknowledgement Type of funding sources: None.

Real-World Data on Bleeding Patterns of Hemophilia A Patients Treated with Emicizumab.

Emicizumab (Hemlibra™) is approved for prophylaxis of hemophilia A (HA) patients. The HAVEN studies addressed bleeding reduction in emicizumab-treated patients, but real-world data on bleeding patterns during emicizumab therapy are lacking. We aimed to compare the occurrence of breakthrough bleeding at different time points, starting from emicizumab initiation. This longitudinal prospective observational cohort study included HA patients (n = 70, aged 1 month to 74.9 years) that completed at least 18 months of follow-up in our center. We analyzed the number of spontaneous and traumatic bleeds during selected time points of the study (“bleeding periods”). The percentage of traumatic and spontaneous bleeding episodes was not significantly different among “bleeding periods” (P = 0.053 and P = 0.092, respectively). Most trauma-related treated bleeds resulted from either hemarthrosis (53%) or head trauma (33%). Spontaneous bleeding episodes were mostly hemarthroses (80%). Potential associations of the patients’ age, annualized bleeding rate before emicizumab treatment, and the presence of inhibitors with spontaneous bleed occurrence were analyzed with binomial logistic regression. The odds of bleeding while on emicizumab increased by a factor of 1.029 (P = 0.034) for every one year of age. Conclusions: Our real-world data revealed that the risk of bleeding persists, especially in older patients, despite therapy with emicizumab. These data may help clinicians in counselling their patients and in planning their management.

A Retrospective Analysis Comparing Post-Operative Bleeding with Various Doses of Aspirin after Lower Extremity Joint Arthroplasty or Revision.

Previous studies have shown that aspirin is noninferior to other anticoagulation therapies in preventing postoperative venous thromboembolism following lower extremity arthroplasty or revision; however, its optimal dosing for this indication is less clear. This study aims to compare the odds of bleeding between different aspirin dosages following lower extremity joint arthroplasty or revision. This is a 3-year retrospective multi-center cohort study across the United States and its territories. This study included patients admitted for total hip or knee arthroplasty or revision and were treated with prophylactic aspirin. Patients were assigned to groups based on a total daily aspirin dose of 81, 162, 325, or 650 mg. Data were analyzed for postsurgical bleeding and thromboembolism events occurring during the initial admission and up to 40 days following surgery. Other exploratory variables included type of surgery, hip or knee arthroplasty, length of stay, and patient demographic data. Among 53,848 patients receiving aspirin, 3922 received a total daily dose of 81 mg, 19,341 received a total daily dose of 162 mg, 5256 received a total daily dose of 325 mg, and 25,329 received a total daily dose of 650 mg. Bleeding occurred in 466 (0.87%) patients and venous thromboembolism (VTE) in 209 patients (0.39%). The odds of bleeding were compared using logistic regression, with the 650-mg dose as the reference group. None were statistically significant for bleeding between all studied aspirin doses: 81 mg (OR 1.12, 95% CI 0.83-1.51, p = 0.451), 162 mg (OR 0.83, 95% CI 0.67-1.03, p = 0.097), and 325 mg (OR 0.83, 95% CI 0.59-1.13, p = 0.245). The odds of VTE were also not statistically significant: 81 mg (OR 0.71, 95% CI 0.40-1.17, p = 0.181), 162 mg (OR 0.75 95% CI 0.54-1.03, p = 0.072), and 325 mg (OR 1.00, 95% CI 0.64-1.53, p = 0.989). There were no significant differences in the odds of bleeding or venous thromboembolism among all studied aspirin dosages in patients receiving aspirin for thromboprophylaxis following lower extremity joint arthroplasty or revision.

Self-reported prevalence of periodontal disease among the Spanish population and immigrants: 2006, 2011/12 and 2017: a population-based study

BackgroundPeriodontal disease is one of the most common pathologies in the population. Self-reporting has been used as a diagnostic tool in large populations, among other reasons, to detect the needs of potentially vulnerable groups. This study evaluated the prevalence of periodontal disease in people of Spanish nationality and immigrants in Spain.MethodsThis population-based, cross-sectional study was carried out using data obtained from National Health Interview Surveys (NHSs) carried out in 2006, 2011/2012 and 2017 in Spain. Subjects aged 16 years and older were included in the NHS-2006 and aged 15 years and older were included in the other NHSs. The following variables were self-reported by the participants: gum bleeding, tooth mobility, tooth extraction and missing teeth. Chi-square homogeneity tests were performed to assess the main associations between the independent variable (nationality) and the dependent variables (bleeding gums, tooth mobility, tooth extraction and missing teeth). Multinomial logistic regression models were constructed to evaluate the influences of the variables age and sex and their interactions on the main associations.ResultsA total of 115,123 participants were included in the NHS-2006 (n = 37,327, 11.38% immigrants), NHS-2011/12 (n = 38,727, 14.39% immigrants) and NHS-2017 (n = 39,069, 13.71% immigrants). The variables directly related to periodontal disease were gum bleeding and tooth mobility. These were significantly associated with nationality in the NHS-2006 and NHS-2017 cohorts. In the NHS-2011/12 cohort, only tooth mobility was associated with nationality. After adjustments for sex, age, and their interactions, immigrant status was associated with increased odds of bleeding in only the NHS-2006 cohort (RR = 1.65, 95% CI 1.38–1.99, p = 0.000).ConclusionImmigrants in Spain have a lower probability of developing signs associated with periodontal disease than the Spanish population. Among the immigrant cohort, females and those in adult age groups had lower prevalence rates than their counterparts.

Baseline hemoglobin and bleeding risk in patients with myocardial infarction treated with PCI

Abstract Background Bleeding is one of the major complications of the modern treatment of myocardial infarction (MI). The data on admission hemoglobin (aHb) and bleeding in patients with MI who underwent percutaneous intervention (PCI) are scarce. Purpose We aimed to investigate the association between the graded aHb level and hospital bleeding in patients with MI who underwent PCI. Methods A single-center retrospective study was performed at our university, a tertiary referral hospital with a 24/7 PCI service. We analyzed 7315 MI patients. The patients were treated according to the published guidelines for the management of MI. The PCI strategy and concomitant medication were left to the discretion of the operator and the attending physician. The groups, stratified at 10g/L intervals according to the Hb level on admission, were compared. The criteria of the Bleeding Academic Research Consortium (BARC) 3a bleeding (an aHb drop of 30–50 g/L or any transfusion) were used. Data were analyzed using descriptive statistics. The interval with the most patients (130–139 g/L) was used as the reference group. The aHb value was used not only as a categorical variable but also as a continuous variable. Results The rates of bleeding were significantly higher in the groups with lower baseline aHb compared to the groups with higher aHb levels (p&amp;lt;0.0001). A nonlinear inverse relationship was observed between the aHb and bleeding (Figure 1). Higher values of aHb were associated with a lower risk of bleeding (adjusted OR 0.76; 95% CI 0.72 to 0.81; p&amp;lt;0.0001). We observed that there was an ∼7.5-fold and an ∼2-fold lower odds of bleeding in the lowest aHb level groups (&amp;lt;100g/L and 100–109 g/L) compared to the reference group, respectively (adjusted OR 7.54; 95% CI 5.38 to 10.56; p&amp;lt;0.0001 and 2.01; 95% CI 1.38 to 2.92) after adjustment for potential confounders. Patients with aHb levels equal to or greater than 110 g/L had a similar bleeding risk to the reference group. Conclusion We found that a graded decrease in the aHb level is associated with a progressively increased risk of hospital bleeding. Patients with aHbs lower than 110 g/L are particularly prone to bleed. Up to now, no consensus has been reached as to whether interventions aimed at correcting anemia could improve the outcome in these patients. Therefore, preventive measures to minimize additional bleeding (radial access, thinner sheaths, the use of selective GPIIb/IIIa receptor antagonists, proton-pump inhibitors) should be used. Even bare-metal stents may be selected, based on the evaluation of the bleeding/thrombosis risk for each patient. In general, the lower the aHb, the greater the bleeding risk. Admission Hb and bleeding Funding Acknowledgement Type of funding source: None

AML-035: Bleeding Outcomes in Thrombocytopenic Acute Leukemia Patients with Venous Thromboembolism at a Comprehensive Cancer Center

Context Cancer-associated thrombosis (CAT) in leukemia patients with severe thrombocytopenia poses a treatment challenge due to competing risks of bleeding and recurrent thrombosis resulting in a narrow therapeutic index for antithrombotic therapies. Objective To determine rates of clinically relevant bleeding (CRB) during management of acute venous thromboembolic event (VTE) in thrombocytopenic acute leukemia patients. Design Retrospective analysis using chart review. Patients Patients (n=74) with acute leukemia admitted to the University of Texas M.D. Anderson Cancer Center, January 2002 - March 2016. Included patients were older than 17 years, with proximal lower extremity deep venous thrombosis and/or pulmonary embolism, and thrombocytopenia (platelet levels ≤50×109/L) on at least two consecutive measures. Patients were sub-grouped into three VTE-treatment interventions: anticoagulation (32.4%), inferior vena cava filter (29.7%), and observation (37.8%). Main outcome measures Rates of CRB and by VTE-treatment intervention group. Association between CRB risk and clinical and laboratory characteristics by multivariate model based on backward model selection. Results Twenty-nine patients (39.2%) suffered CRB during the study (9 had clinically relevant non-major bleeding, 19 had major bleeding, and 1 had both major and non-major bleeding). Patients with relapsed leukemia bled more than those with de novo leukemia (P=0.0294). The use of anticoagulation did not increase the occurrence of CRB (P=0.6035). Use of chemotherapy increased the odds of bleeding by six times (P=0.043). Patients with CRB received more transfusions of platelets (P=0.0012), packed red blood cells (P=0.0017), and fresh frozen plasma (P=0.0573) compared to those who did not bleed. Baseline platelet count was not a significant factor associated to CRB(P=0.35), but the rate of increased platelet counts over time correlated with decreased bleeding chance (P=0.01). Conclusions There was a significant correlation between the occurrence of CRB and quantity of overall blood product transfusions, use of chemotherapy, and relapsed leukemia presentation. There was no difference in rates of CRB between VTE-treatment sub-groups, regardless of platelet count at time of VTE diagnosis. It appears the platelet count trajectory and the factors associated to a slower recovery of it are the main determinants for hemorrhagic complications during VTE treatment in acute leukemia.

Effect of thromboprophylaxis on the incidence of venous thromboembolism in surgical patients with colorectal cancer: a meta-analysis.

This study evaluates the role of thromboprophylaxis in venous thromboembolism (VTE) incidence in colorectal cancer (CRC) surgical patients. Literature search was conducted in electronic databases and studies (randomized controlled trials, or prospective/retrospective cohorts) were selected if they reported the incidence of VTE in CRC patients who underwent any type of open or laparoscopic surgery. Random-effects meta-analyses were performed to obtain pooled incidence estimates; or odds ratios (OR) of incidence between prophylaxis and no-prophylaxis groups; or between VTE and non-VTE patients to identify risk factors. Twenty-four studies (804,003 patients) were included. Prophylaxis was performed mainly with low molecular weight heparins. Odds of VTE were significantly lower in prophylactic than in non-prophylactic patients (OR 0.42 [95% CI: 0.28, 0.63]; P<0.00001). Incidence of radiological and symptomatic VTE in patients with prophylaxis was 9.7% [95% CI: 8.6, 10.8] and 1.3% [95% CI: 0.7, 2.0] respectively. Odds of bleeding were higher in patients with prophylaxis (OR: 3.37 [95% CI: 1.05, 10.8]; P=0.04). Incidence of bleeding in patients with and without prophylaxis was 4.3% [95% CI: 3.2, 5.4] and 1.2% [95% CI: 0.02, 2.4] respectively. Operative time, anesthesia duration, and hospital stay were longer in patients with VTE. Obesity, disseminated cancer, chemotherapy, steroid use, emergency case status, advanced stage cancer, hypoalbuminemia, postoperative infection/sepsis, and history of VTE are identified as important risk factors for VTE incidence. Thromboprophylaxis reduces the incidence of VTE in CRC surgical patients but may increase the chances of bleeding. Several risk factors can influence VTE incidence.

P2816Antithrombotic strategy for patients with anticoagulation indication undergoing percutaneous coronary intervention: meta-analysis of randomised controlled trials

Abstract Background A significant proportion of patients having acute coronary syndrome and/or undergoing percutaneous coronary intervention (PCI) have indications for long-term anticoagulation such as atrial fibrillation. Their optimal antithrombotic strategy despite recent randomised trials. We meta-analysed outcomes comparing dual versus triple, and non-vitamin K oral anticoagulants (NOAC) versus vitamin K oral anticoagulants (VKA) antithrombotic regimens. Methods MEDLINE, Embase and Cochrane databases were searched for original randomised trials with relevant search terms. Two authors evaluated these studies for inclusion and extracted data pooling bleeding and cardiovascular events. Results The search yielded 308 articles, with 19 full-texts reviewed and 4 randomised trials totalling 6,029 patients included. Dual antithrombotic strategies were associated with significant reductions in TIMI major and minor bleeding (odds ratios 0.55, 95% confidence interval 0.36–0.83), and other bleeding endpoints including all, major, minor and intracranial bleeding (odds ratios 0.45–0.62, all P&lt;0.05), compared with triple antithrombotic strategies in four trials, with no differences in mortality, myocardial infarction, stroke, stent thrombosis or composite cardiovascular events (odds ratio 0.79–1.13, all P&gt;0.05). NOAC regimens were associated with significant reductions in TIMI major and minor bleeding odds ratio 0.49 (0.37–0.65), as well as major, minor and intracranial bleeding (odds ratios 0.29–0.52, all P&lt;0.05), but again no differences in mortality or all cardiovascular endpoints (odds ratios 0.98–1.49, all P&gt;0.05). Conclusion Antithrombotic strategies involving dual instead of triple agents, and NOAC instead of VKA had significantly less bleeding without increasing mortality and cardiovascular events, and are therefore preferred options in patients undergoing PCI who also require long-term anticoagulation.

High-dose heparin is associated with higher bleeding and thrombosis rates in pediatric patients following cardiac surgery

ObjectiveTo determine the association between unfractionated heparin (UFH) dose and the rate of postoperative bleeding and thrombosis events in pediatric cardiac patients. We tested the hypothesis that high-dose UFH is associated with higher rates of bleeding and thrombosis. MethodsThis is a retrospective review of pediatric patients admitted to the cardiac intensive care unit following cardiac surgery between November 2016 and December 2017. Peripheral venous thrombosis was excluded from analysis. Bleeding was defined as spontaneous bleeding remote from procedural manipulation. Postoperative UFH dosing strategy was categorized into 3 groups: no UFH, low-dose UFH (<15 U/kg/h) and high-dose UFH (≥15 U/kg/h). Statistical analysis was performed using multivariable logistic regression. ResultsWe observed 966 consecutive patients (median age, 1.37 years; interquartile range, 0.27-5.50 years) during their stay in the cardiac intensive care unit. There were 94 patients (10%) with bleeding and 52 patients (5%) with thrombosis during follow-up. Patients receiving high-dose UFH experienced significantly more bleeding (odds ratio, 2.35; 95% confidence interval, 1.45-3.95) and thrombosis events (odds ratio, 3.65; 95% confidence interval, 1.81-7.38) compared with patients receiving low-dose UFH. The odds of bleeding (odds ratio, 0.81; 95% confidence interval, 0.45-1.47) and thrombosis (odds ratio, 0.59; 95% confidence interval, 0.26-1.35) were similar in the low-dose UFH and no-UFH groups. ConclusionsBleeding remote from immediate postsurgical bleeding occurs uncommonly in pediatric patients following cardiac surgery. Anticoagulation with high-dose UFH is associated with higher bleeding rates as well as higher thrombosis rates. Indications for high-dose UFH should be carefully considered to reduce the rate of bleeding in this population.

Oral Health Status of 12- and 15-Year-Old Students in Qatar: Findings From the National Oral Health Survey

Background The national oral health survey-Qatar was carried out in 2011 in an attempt to establish the baseline information about oral health status among youth. This article describes the oral health status of 12 and 15-year-old students in Qatar. Methods Cross-sectional survey data were analyzed for 12 (N=1060) and 15 (N=1064) year-old students. The caries status based on decayed, missing, filled teeth or DMFT=0 (no caries) &amp; DMFT≥1 (caries present). Mean indices among nationalities and sex were compared by student’s t-test. Analysis of variance (ANOVA) was used to compare means by the type of the school. Logistic regression was used to examine associations among available variables. Results In the overall sample, 53.3% (n=565) of 12-year-olds and 55.4% (n=589) of 15-year-olds had varying levels of dental caries. The odds of dental caries were higher among girls compared to boys aged 12 years (OR=1.3, CI=1.0-1.6, P=0.05) as well as 15 years old (OR=1.28, CI=1.01-1.6, P=0.04) respectively. By nationality, Qatari students had a higher mean DMFT value (1.3 ± 1.2) compared to non-Qataris (0.82 ± 1.1). The public/independent attendees had higher mean DMFT values (1.31 ± 1.2) compared to the other two school categories. Fifteen-year-old students had lower odds (OR=0.81, CI- 0.68-0.97, P=0.02) of gingival bleeding and higher odds (OR=1.68, CI=1.4-2.1, P&lt;0.001) of calculus compared to 12-year-olds. Dental fluorosis was found among 15% of 12 years old and 16.6% of 15 years old. The odds of fluorosis were higher among 15 years old but this relationship was not significant (OR=1.1, CI=0.88-1.4, P=0.36). Lower odds of bleeding teeth (OR=0.81, CI=0.68-0.97, P=0.02) and higher odds of calculus were found among 15 years old (OR=1.68, CI=1.4-2.1, P&lt;0.001) compared to 12 years. Conclusions The results provide directions to further strengthen the oral health strategies through various evidence-based interventions.Background

Abstract 48: Which Patients With Acute Ischemic Stroke Benefit From the Lower Dosage of Intravenous Tissue Plasminogen Activator? A Cluster Data Analysis

Introduction: Although intravenous alteplase(tPA) in acute ischemic stroke(AIS) has been proved as the standard treatment, there remain concerns about increased risk of symptomatic intracranial hemorrhage. Lower dosage of tPA has been used in Japan and other Asian countries. We aim to find which AIS patients benefit from the lower dosage of intravenous tPA. Methods: We used the TIMS-CHINA database of 1440 stroke patients from 67 centers and the 4S database of 2779 patients from 11 centers. Both databases include AIS stroke patients treated with tPA, recorded with similar medical databases structures. The variables include the severity of stroke at baseline (NIHSS score), onset to needle time, dosage of tPA, symptomatic intracranial hemorrhage(sICH), modified Rankin Scale(mRS) at 3 months. We used a machine-learning method of subgroup analysis using decision trees with recursive portioning. Results: In this cluster analysis, the appropriate dosage in subsets of acute ischemic stroke patients has been explored. Based on NIHSS score to optimize the interaction effect between t-PA dosage (standard/lower), three subgroups were defined as NIHSS (1) ≤4, (2) 5-14, and (3)≥15. Their risk of sICH and benefit (as mRS0-1) are identified. The estimated difference in log odds of bleeding between standard and lower dosage is: -0.85 (p=0.15) for Group 1, 1.95 (p=0.02) for Group 2, and 0.39 (p=0.56) for Group 3, after effect adjustment of other factors and bias reduction. We are especially careful about bias reduction due to rare events: the number of bleeding cases can be small in certain subgroups. The estimated difference in log odds of efficacy between standard and lower dosage is: 0.16 (p=0.49) for Group 1, -0.16 (p=0.57) for Group 2, and -0.08 (p=0.80) for Group 3, after effect adjustment of other factors. Conclusion: Our results advocate using a lower dosage of tPA in moderate stroke, which significantly reduce the bleeding risk while achieving non-inferior performance in efficacy

Bridging Anticoagulation After Mechanical Aortic Heart Valve Replacement: A Questionable Routine

This retrospective single-center study evaluates differences in bleeding and thrombotic events between a homogenous group of patients undergoing mechanical aortic valve replacement who either received or did not receive intravenous unfractionated heparin or subcutaneous low-molecular weight heparin as bridging strategy to warfarin therapy. Clinical data on a total of 158 patients undergoing mechanical aortic valve replacement at our center between 2001 and 2014 were collected. Patients were grouped according to postoperative anticoagulation strategy: warfarin only (n= 53) and warfarin plus heparin bridge (n= 105). The outcomes of interest were bleeding event and thromboembolic event recorded during hospital stay. Patients' baseline characteristics were comparable between the two groups except for preoperative atrial fibrillation, which was more common in the warfarin plus heparin group than the warfarin group (p= 0.04). There were significantly more bleeding complications in the warfarin plus heparin group versus warfarin group as evidenced by higher rates of pericardial effusions (24% versus 8%, p= 0.02) and reoperation for bleeding (8% versus 0%, p= 0.05). All observed thromboembolic events (n= 4) occurred in the warfarin plus heparin group (p= 0.55). Logistic regression analysis identified group assignment (warfarin plus heparin versus warfarin only) to be significantly associated with the odds of bleeding (odds ratio 4.46, 95% confidence interval:1.42 to 14.02, p= 0.01). Bridging anticoagulation therapy increases the chances of bleeding in the postoperative phase for mechanical aortic valve replacement patients. Owing to low incidence, no statistically significant difference was detected for thromboembolic event rates.