Odds Of Hemorrhage Research Articles

Elective intervention for unruptured cranial arteriovenous malformations in relation to ARUBA trial: a National Inpatient Sample study.

In 2014, A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) concluded that medical management alone for cranial arteriovenous malformations (AVMs) had better clinical outcomes than interventional treatment. The impact of the ARUBA study on changes in the rates of intervention and outcomes is unknown. Thus, we investigated whether the conclusions from ARUBA may have influenced treatment modalities and outcomes of unruptured AVMs. The National Inpatient Sample (NIS) was queried between 2006 and 2018, for adult patients with an AVM who were admitted on an elective basis. Interventions included open, endovascular, and stereotactic surgeries. Join-point regression was used to assess differences in slopes of treatment rate for each modality before and after the time-point. Logistic regression was used to assess the odds of non-routine discharge and hemorrhage between the two time-points for each treatment modality. Linear regression was used to assess the mean length of stay (LOS) for each treatment modality between the two time-points. A total of 40,285 elective admissions for AVMs were identified between 2006 and 2018. The rate of intervention was higher pre-ARUBA (n = 15,848; 63.8%) compared to post-ARUBA (n = 6985; 45.2%; difference in slope - 8.24%, p < 0.001). The rate of open surgery decreased, while endovascular and stereotactic surgeries remained the same, after the ARUBA trial time-point (difference in slopes - 8.24%, p < 0.001; - 1.74%, p = 0.055; 0.20%, p = 0.22, respectively). For admissions involving interventions, the odds of non-routine discharge were higher post-ARUBA (OR 1.24; p = 0.043); the odds of hemorrhage were lower post-ARUBA (OR 0.69; p = 0.025). There was no statistical difference in length of stay between the two time-points (p = 0.22). The rate of intervention decreased, the rate of non-routine discharge increased, and rate of hemorrhage decreased post-ARUBA, suggesting that it may have influenced treatment practices for unruptured AVMs.

Safety, Utilization, and Cost of Image-Guided Percutaneous Liver Biopsy Among Cancer Patients

Image-guided percutaneous liver biopsy (PLB) is a diagnostic tool for lesions in the liver. Hemorrhage is the most common complication. We selected patients with a diagnostic claim for cancer who had undergone PLB. There were a total of 26,941 patients who underwent PLB. Hemorrhage risk was 1.43% among patients undergoing PLB. When stratified by setting, odds of hemorrhage were 4.5 times higher when biopsy was performed in an inpatient setting (p < .001). Risk factors associated with hemorrhage included marital status, liver cancer and comorbidity score. The use of PLB has increased over time. Reassuringly, the hemorrhage risk associated with PLB is low.

Abstract 2424: Who Bleeds? Predicting Intracranial Bleeding in Patients with Acute Ischemic Stroke and an Indication for Anticoagulation

Introduction: Many patients with acute ischemic stroke also have an indication for anticoagulation. A major concern in these patients is whether they are at increased risk for intracranial bleeding, and if so, what factors further increase their risk. We evaluated stroke patients with an indication for anticoagulation to determine what factors are associated with increased risk of intracranial bleeding. Methods: Patients presenting with acute ischemic stroke and an indication for anticoagulation were included in analysis. Data were collected in the following categories: demographics (age, race, gender), medical profile (blood pressure, glycemic control, statin use/LDL, renal function [divided into GFR categories- 0: GFR ≥60, 1: GFR 30-59, or 2: GFR &lt;30], antiplatelet use, anticoagulation status), and stroke characteristics (type of stroke, time from onset of symptoms to anticoagulation, NIH Stroke Scale). Stroke volume, gradient echo positivity, and evidence of intracranial bleeding on head CT and MRI were also assessed. Hemorrhages were classified as: hemorrhagic conversion (petechiae) versus intracranial hemorrhage (a space occupying lesion), and symptomatic versus asymptomatic (based on subjective clinical worsening noted by the primary neurology team). Using stepwise regression analysis we determined which factors were associated with increased risk of intracranial bleeding (with any intracranial bleeding as the primary outcome). Results: 143 patients (mean age 63.5 years) met criteria and were included in analysis. 117 were placed on anticoagulation. The most common indications for anticoagulation were atrial fibrillation (35.6%), deep vein thrombosis (27.3%), presence of a hypercoagulable state (18.2%), and pulmonary embolism (17.5%). The difference in bleeding rates between those placed on anticoagulation and those treated with an antiplatelet agent was not statistically significant (25.6% versus 23.1%, χ2=0.785), but all of the intracranial hemorrhages (n=8) and symptomatic bleeds (n=9) occurred in the anticoagulated group. Age (OR= 1.31 per 10 year increment, 95% CI 0.98-1.74), volume (OR= 1.13 per 10 cc’s, 95% CI 1.05-1.21), and worsening GFR category (OR= 1.81, 95% CI 1.01-3.26) were predictors of intracranial bleeding. Odds of hemorrhage was predicted by exponentiating the equation: -3.823563 + (0.0120706)*(Volume) + (0.5939482)*(GFR Category) + (0.0266442)*(Age). Probability of hemorrhage can then be calculated. Conclusions: Probability of intracranial bleeding in patients with acute ischemic stroke and an indication for anticoagulation can be calculated based on an individual’s age, stroke volume, and GFR. This score can be used to assist with prognosis and clinical management. While anticoagulation does not appear to increase risk of bleeding, it does tend to result in larger, more symptomatic bleeds.