Outcomes Of Gastrointestinal Bleeding Research Articles

Overt gastrointestinal bleeding in patients with cancer: Clinical characteristics and outcomes

Background/goalsThe aim of this study was to compare the clinical characteristics and outcomes of gastrointestinal bleeding (GIB) between cancer patients (CP) and non-cancer patients (NCP). StudyThis was a prospective study of patients admitted with overt GIB between 2013 and 2021. GIB etiology, management and outcomes including rebleeding and mortality, were compared between CP and NCP, and among patients with different types of cancer. The associations with categorical variables were assessed with the Chi-square test, and the t-test was used for continuous variables. ResultsOf 674 patients admitted for GIB, 144 (21%) had cancer. 121(84%) CP had active disease, 49% had stage 4 cancer, and 78% had solid tumors, of whom 28 (20%) had luminal GI cancers. The most common were colorectal cancer, prostate cancer, and lymphomas. Compared to NCP, CP had higher age-adjusted Charlson Comorbidity Index, and were less likely to undergo endoscopy or endoscopic therapy. Severe GIB was equally prevalent in both groups, but CP had more severe anemia. Peptic ulcer was the most common etiology in both groups. Of 28 luminal cancer patients, 17(59%) bled from their tumors. Nine patients bled from cancer metastasis to the GI lumen. CP had higher in-hospital, one-month, one-year, and end-of-follow-up mortality. Length of hospital stay and re-bleeding rates did not differ between CP and NCP. ConclusionCP with GIB are less likely to have diagnostic and therapeutic endoscopy and have higher mortality than NCP. Steps to identify CP at risk for GIB and to improve their outcomes merit further investigation.

The Role of Hospital Characteristics in Clinical and Quality Outcomes for Gastrointestinal Bleeding in a National Cohort.

There is substantial variability in patient outcomes for gastrointestinal bleeding (GIB) across hospitals. This study aimed to identify hospital factors associated with GIB outcomes. This was a retrospective cohort study of Medicare fee-for-service beneficiaries hospitalized for GIB from 2016-2018. These data were merged with the American Hospital Association Annual Survey data to incorporate hospital characteristics. We used generalized linear mixed effects models to estimate the effect of hospital level characteristics on patient outcomes after adjusting for patient risk factors including anticoagulant and antiplatelet use, recent GIB, and comorbidities. The primary outcome was 30-day mortality and secondary outcomes included length of stay (LOS), and a composite outcome of 30-day readmission or mortality. Factors associated with improved GIB 30d mortality included large hospital size (defined as beds>400, OR: 0.93 (0.90, 0.97)), greater case volume (OR 0.97 (0.96, 0.98)) increased residents and nurse staffing (OR: 0.88 (0.83, 0.94)), and blood donor center designation (OR: 0.93 (0.88, 0.99)). Patients treated at a hospital with multiple advanced capabilities, such as availability of advanced endoscopy, advanced ICU capabilities (both a medical-surgical ICU and cardiac ICU), blood donor center, and liver transplant center, had a 22% reduction in 30-day mortality risk, compared to those hospitalized in a hospital with none of these services (OR: 0.78 (0.68, 0.91)). However, LOS increased with additional services. Patients hospitalized for GIB at hospitals with multiple advanced specialized capabilities have lower mortality but longer lengths of stay. Further research should examine the processes of care linked to these services that contribute to improved mortality in GIB.

Causes of gastrointestinal bleeding in children based on endoscopic evaluation at a tertiary care center in Bahrain.

Gastrointestinal bleeding (GIB) is a serious health problem worldwide, particularly during childhood. This can be an alarming sign of an underlying disease. Gastrointestinal endoscopy (GIE) is a safe method for the diagnosis and treatment of GIB in most cases. To determine the incidence, clinical presentation, and outcomes of GIB in children in Bahrain over the last two decades. This was a retrospective cohort review of the medical records of children with GIB who underwent endoscopic procedures in the Pediatric Department at Salmaniya Medical Complex, Bahrain, between 1995 and 2022. Demographic data, clinical presentation, endoscopic findings, and clinical outcomes were recorded. GIB was classified into upper (UGIB) and lower (LGIB) GIB according to the site of bleeding. These were compared with respect to patients' sex, age, and nationality using the Fisher's exact, Pearson's χ 2, or the Mann-Whitney U tests. A total of 250 patients were included in this study. The median incidence was 2.6/100000 per year (interquartile range, 1.4-3.7) with a significantly increasing trend over the last two decades (P < 0.0001). Most patients were males (n = 144, 57.6%). The median age at diagnosis was 9 years (5-11). Ninety-eight (39.2%) patients required upper GIE alone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. LGIB was more frequent (n = 151, 60.4%) than UGIB (n = 119, 47.6%). There were no significant differences in sex (P = 0.710), age (P = 0.185), or nationality (P = 0.525) between the two groups. Abnormal endoscopic findings were detected in 226 (90.4%) patients. The common cause of LGIB was inflammatory bowel disease (IBD) (n = 77, 30.8%). The common cause of UGIB was gastritis (n = 70, 28%). IBD and undetermined cause for bleeding were higher in the 10-18 years group (P = 0.026 and P = 0.017, respectively). Intestinal nodular lymphoid hyperplasia, foreign body ingestion, and esophageal varices were more common in the 0-4 years group (P = 0.034, P < 0.0001, and P = 0.029, respectively). Ten (4%) patients underwent one or more therapeutic interventions. The median follow-up period was two years (0.5-3). No mortality was reported in this study. GIB in children is an alarming condition, whose significance is increasing. LGIB, commonly due to IBD, was more common than UGIB, commonly due to gastritis.

Effect of the COVID-19 pandemic on the epidemiological trends and outcomes of gastrointestinal bleeding: a nationwide study

The COVID-19 pandemic altered healthcare delivery in the United States. This study examined the effect of the COVID-19 pandemic on the epidemiological trends and outcomes of gastrointestinal bleeding. We compared the admission rate, in-hospital mortality rate, and mean length of hospital stay between 2019 and 2020 to estimate the pandemic effect. The study highlighted disparities in outcomes of gastrointestinal bleeding hospitalizations stratified by sex and race. We noted a 9.5% reduction in the total number of hospitalizations in 2020. We also observed a 13% increase in overall mortality during the pandemic (P < 0.001). There was a 15.8% increase in mortality among men (P = 0.007), compared to a 4.7% increase among women (P = 0.059). There was a significant increase in mortality among Whites in 2020 compared to Black and Hispanic populations. On multivariable logistic regression, admission during the COVID-19 pandemic was associated with increased length of stay when adjusted for age, sex, and race. Despite the direct COVID-19–related morbidity and mortality, the so-called indirect effect of the pandemic cannot be overlooked. For the remainder of the pandemic and future health emergencies, it is critical to balance mitigation of the spread of the contagion with clear public health messages to not neglect other life-threatening emergencies.

S677 Overt Gastrointestinal Bleeding in Patients With Cancer: Clinical Characteristics and Outcomes

S677 Overt Gastrointestinal Bleeding in Patients With Cancer: Clinical Characteristics and Outcomes

Incidence and Outcomes of Gastrointestinal Bleeding in Patients With Percutaneous Mechanical Circulatory Support Devices

Percutaneous mechanical circulatory support (pMCS) devices are increasingly used in patients with cardiogenic shock as a bridge to recovery or bridge to decision to advanced heart failure therapies. Gastrointestinal bleeding (GIB) is a common complication that can be catastrophic. Because of the paucity of data describing the association of GIB with pMCS, we analyzed this population using the United States National Inpatient Sample database. We performed a retrospective study in patients with pMCS devices who had GIB during the index hospitalization using the National Inpatient Sample. Multivariate logistic regression analysis was performed to determine independent predictors of GIB in these patients. A total of 466,627 patients were included. We observed an overall increase in the incidence of adjusted GIB from 2.9% to 3.5% (p=0.0025) from 2005 to 2014. In comparison to patients without GIB, those with GIB had significantly higher in-hospital mortality, length of stay, and hospitalization cost. In addition to the usual co-morbid conditions, the presence of small bowel and colonic ischemia, colon cancer, diverticulosis, chronic liver disease, and peptic ulcer disease were noted to be significant predictors of GIB for all (p <0.001). In conclusion, patients with pMCS and GIB have higher in-hospital mortality, longer length of stay, and higher cost of hospitalization. Awareness of patient risk factors for bleeding and gastrointestinal disorders are important before the use of mechanical circulatory support devices because they are associated with a substantially higher risk for bleeding.

Incidence and outcome of gastrointestinal bleeding in patients receiving aspirin with or without clopidogrel over 10 years- An observational study.

To determine the long-term incidence and outcome of gastrointestinal (GI) bleeding in users of aspirin with (dual antiplatelet therapy, DAPT) or without clopidogrel. Prospective hospital based 12-year study. There were 1047 patients on either aspirin 150 md/day alone (n = 574, 54.8%) or aspirin 75 md/day + clopidogrel 75 md/day (n = 473, 45.2%) were followed up for any incident GI bleed, rebleed and mortality. Those simultaneously using other drugs known to cause GI bleeding were excluded. Comorbidities, concomitant use of proton pump inhibitors and statins were noted. GI bleed occurred in 11.8% after 8,683 person years of follow up. 56 (45%) patients had lower GI source of bleed [colon 9 (7%), small gut 47 (38%)] and 68 (55%) had upper GI source [duodenum 39 (32.3%), stomach 28 (22.6%) and oesophagus 1 (0.1%)]. Whereas stomach and duodenum were the chief sites in the first year, small gut predominated in later years. The cumulative bleeding rate after 1, 5 and 10 years was 5%, 8% and 11%, respectively, higher in the DAPT group. Bleeding stopped spontaneously in 98% on drug withdrawal, and 7.3% patients rebled in the next 6.2 years. The overall mortality was 33.1% but only 1.6% was due to the bleed being significantly lower in the DAPT group. On multivariate analysis coronary interventions, diabetes mellitus, renal and multiorgan dysfunction were the significant predictors of GI bleed and mortality. Though the incidence and mortality are low, GI bleed increases with longer use of antiplatelet agents predominantly from the lower GI tract.

Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists.

Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce. To evaluate the severity, etiology and outcomes of GIB in patients under DOACs compared to VKA. Patients under oral anticoagulant therapy admitted to the emergency department with acute GIB were prospectively recruited from July 2016 to January 2018 at a tertiary referral hospital. Demographic and clinical outcome were obtained from medical records. Severity of the GIB event was classified as mild, major or severe according to clinical presentation and the type of support needed. Etiology and location of bleeding, number of packed red blood cells transfused (PRBC) and length of hospital stay were recorded until discharge or in-hospital death. A total of 208 patients with acute GIB under oral anticoagulant treatment were recruited: 119 patients were on VKA and 89 patients on DOAC with similar characteristics. Thirty-one patients had severe GIB; 134 major and 43 mild, with no differences in severity, number of PRBC and length of hospital stay between the groups. Peptic disease was the most frequent etiology of GIB in patients on VKA (20.2 % vs. 13.6%, p=0.20). Diverticular bleeding was the most frequent adverse event in patients on DOAC (14.3% vs. 24.8%, p= 0.056). Severity and clinical outcomes of GIB are similar between patients on DOAC and patients on VKA, regardless of etiology of GIB.

Outcomes of Gastrointestinal Bleeding During the COVID-19 Pandemic.

The novel circumstances during the pandemic have led to many challenges for clinicians and patients, which includes cancellation of procedures, policy regulations, and the reluctance of patients to seek medical attention potentially leading to adverse outcomes.1,2 Although outpatient appointments and elective procedures are less likely to affect short-term patient outcomes, the delay in seeking care for medical emergencies can be devastating. Gastrointestinal bleeding (GIB) is a commonly encountered emergency.

Clinical features, management and outcomes of gastrointestinal bleeding in patients treated with oral anticoagulants

Abstract Background Gastrointestinal (GI) bleeding with the different antithrombotics may present peculiarities in terms of location, precipitating factors, clinical management and prognosis. Purpose Our objective was to compare the profile and clinical course of GI bleeding with direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA). Methods We carried out a retrospective study of all consecutive patients treated in a tertiary hospital during 2018 and 2019, and who met the following selection criteria: 1) diagnosis of confirmed or probable GI bleeding; 2) red blood cell transfusion; 3) treatment with an oral anticoagulant; 4) absence of concomitant antiplatelet therapy. We collected information on comorbidities, bleeding risk scores, baseline treatments, and clinical course of bleeding. We compared adjusted all-cause mortality at 12-months between DOACs and VKAs groups. Results We identified 115 patients with GI bleeding, mean age 83±9 years, 63% women, 50.4% on DOACs and 49.6% on VKAs. NOACs group showed more recent anticoagulation history, and more complex clinical profile, with older age (85 vs. 82 years, p=0.026), number of comorbidities (2.7 vs. 2.1, p=0.049), CHA2DS2VASc score (5.2 vs. 4.2, p=0.001) and ORBIT score (3.9 vs. 3.3, p=0.047). There were no differences in the location of bleeding (60.5% lower GI tract), number of units transfused (mean 2.6), or hemoglobin nadir (mean 7.6 g/dL). Notably, 42% of the patients on DOACs were receiving the high dose at the time of bleeding, 63% of them had some risk criterion for overdose (age&amp;gt;80 years, weight &amp;lt;60 kg, moderate P-glycoprotein inhibitors), and 37% had &amp;gt;1 of these criteria. 12-month cumulative mortality was high, but significantly lower in the DOACs group (15.5% vs. 35.7%, adjusted HR 0.31, p=0.002). Conclusions Patients who experience GI bleeding with anticoagulants represent a therapeutic challenge, with both high age and prevalence of comorbidities. One-year mortality is remarkably high, particularly in the VKA group. Our findings emphasize the need for close monitoring and optimization of preventive strategies in this complex clinical scenario. Funding Acknowledgement Type of funding sources: None.

Risk factors and outcomes of gastrointestinal bleeding in patients with stable coronary artery disease: data from the observational registry of long-term antithrombotic therapy REGATTA-1

Aim. To optimize the upper gastrointestinal bleeding (UGIB) risk scale in patients Material and methods. The UGIB risk scale was developed based on the with chronic coronary artery disease (CAD) receiving long-term antiplatelet therapy. prospective REGistry of long-term AnTithrombotic TherApy-1 REGATTA-1(ClinicalTrials.gov Identifier: NCT04347200). The registry includes 934 patients with stable CAD (men, 78,6%; median age, 61±10,7 years), 76% of whom were included after elective percutaneous coronary interventions and received dual antiplatelet therapy for 6-12 months. After a UGIB episode, patients were prescribed proton pump inhibitors. The 2015 European Society of Cardiology (ESC) scale was used for assessing the UGIB risk. In addition, we evaluated the ultrasound data on atherosclerotic burden (abdominal aorta and peripheral arteries).Results. The median follow-up was 2,5 years [1,1-14,7 years]. The incidence of UGIB was 1,9 cases per 100 patient/years. Recurrent UGIB episodes and thrombosis was recorded in 13,7% and 31,4%, respectively. Based on the results of a multivariate logistic regression, a novel scale for assessing the UGIB risk (REGATTA) has been developed. In accordance with the odds ratio, points were assigned for each independent risk factor (RF): age ≥80 years — 3 points, prior gastric erosion, peptic ulcer disease or UGIB — 3 points for each RF, anticoagulation therapy — 4 points, non-steroidal antiinflammatory drug therapy — 2 points. The atherosclerotic burden (peripheral atherosclerosis and/or abdominal aortic aneurysm; 2 points) and heart failure (in most cases after a myocardial infarction; 2 points) were marked as a new independent predictor. The cutoff value (≥4 points) was determined, reflecting the high UGIB risk (sensitivity, 80,4%; specificity, 84,5%). The REGATTA scale was more powerful than the traditional 2015 ESC scale: AUC of 0,88, (95% confidence interval, 0,86-0,9) vs AUC of 0,79, (95% confidence interval, 0,760,82) (p=0,04).Conclusion. The identified UGIB predictors (atherosclerotic burden and heart failure) and the developed REGATTA scale made it possible to improve the prognosis and prevention of UGIB in patients with stable CAD receiving long-term antiplatelet therapy.

Characteristics, Location, and Clinical Outcomes of Gastrointestinal Bleeding in Patients Taking New Oral Anticoagulants Compared to Vitamin K Antagonists.

New oral anticoagulants (NOACs) are commonly used in clinical practice as alternatives to vitamin K antagonists (VKA). However, the etiology, clinical course, and risk of gastrointestinal (GI) bleeding remain unclear. We aimed to evaluate the clinical characteristics and location of acute GI bleeding associated with NOACs and its severity and outcomes compared to VKA. This retrospective multicenter study included 381 subjects on anticoagulants who underwent appropriate diagnostic examination due to GI bleeding. Regarding the characteristics of acute GI bleeding, the proportion of vascular lesions was significantly lower in the NOACs group than that in the VKA group. Small bowel bleeding occurred less commonly in the NOACs group, but the difference did not reach statistical significance. Regarding severity and clinical outcomes, patients on NOACs received significantly smaller volumes of transfused blood products and had shorter ICU stays than those on VKA. Moreover, the need for surgery and the risk of rebleeding in the NOACs group were significantly lower than those in the VKA group. Patients on NOACs have better clinical outcomes in terms of severity of acute GI bleeding or rebleeding than patients on VKA. Patients on NOACs demonstrate different characteristics and location of acute GI bleeding than those on VKA.

Glasgow-Blatchford Score Predicts Post-Discharge Gastrointestinal Bleeding in Hospitalized Patients with Heart Failure.

Background: The Glasgow-Blatchford Score (GBS) is one of the most widely used scoring systems for predicting clinical outcomes for gastrointestinal bleeding (GIB). However, the clinical significance of the GBS in predicting GIB in patients with heart failure (HF) remains unclear. Methods and Results: We conducted a prospective observational study in which we collected the clinical data of a total of 2236 patients (1130 men, median 70 years old) who were admitted to Fukushima Medical University Hospital for acute decompensated HF. During the post-discharge follow-up period of a median of 1235 days, seventy-eight (3.5%) patients experienced GIB. The GBS was calculated based on blood urea nitrogen, hemoglobin, systolic blood pressure, heart rate, and history of hepatic disease. The survival classification and regression tree analysis revealed that the accurate cut-off point of the GBS in predicting post-discharge GIB was six points. The patients were divided into two groups: the high GBS group (GBS > 6, n = 702, 31.4%) and the low GBS group (GBS ≤ 6, n = 1534, 68.6%). The Kaplan–Meier analysis showed that GIB rates were higher in the high GBS group than in the low GBS group. Multivariate Cox proportional hazards analysis adjusted for age, malignant tumor, and albumin indicated that a high GBS was an independent predictor of GIB (hazards ratio 2.258, 95% confidence interval 1.326–3.845, p = 0.003). Conclusions: A high GBS is an independent predictor and useful risk stratification score of post-discharge GIB in patients with HF.

Characteristics and outcomes of gastrointestinal bleeding in patients with continuous-flow left ventricular assist devices: A systematic review.

Gastrointestinal bleeding (GIB) is a common adverse event after continuous-flow left ventricular assist device (CF-LVAD) implantation. We sought to evaluate patterns of GIB development and related outcomes in CF-LVAD recipients. An electronic search was performed to identify all articles related to GIB in the setting of CF-LVAD implantation. A total of 34 studies involving 1087 patients were pooled for analysis. Mean patient age was 60 years (95% CI 57-64) and 24% (95% CI 21-28%) were female. The mean time from CF-LVAD implantation to the first GIB was 54 days (95% CI 24-84) with 40% (95% CI 34-45%) of patients having multiple episodes of GIB. Anemia was present in 75% (95% CI 41-93%) and the most common etiology of bleeding was arteriovenous malformations (36% [95% CI 24-50%]). The mean duration of follow-up was 14.6 months (95% CI 6.9-22.3) during which the all-cause mortality rate was 21% (95% CI 12-36%) and the mortality rate from GIB was 4% (95% CI 2-9%). Thromboembolic events occurred in 32% (95% CI 22-44%) of patients with an ischemic stroke rate of 16% (95% CI 3-51%) and a pump thrombosis rate of 8% (95%CI 3-22%). Heart transplantation was performed in 31% (95% CI 18-47%) of patients, after which 0% (95% CI 0-10%) experienced recurrent GIB. GIB is a major source of morbidity among CF-LVAD recipients. While death due to GIB is rare, cessation of anticoagulation during treatment increases the risk of subsequent thrombotic events. Heart transplant in these patients appears to reliably resolve the risk of future GIB.

Effect of the Coronavirus 2019 Pandemic on Outcomes for Patients Admitted With Gastrointestinal Bleeding in New York City

Effect of the Coronavirus 2019 Pandemic on Outcomes for Patients Admitted With Gastrointestinal Bleeding in New York City

Trends and Outcomes of Gastrointestinal Bleeding Among Septic Shock Patients of the United States: A 10-Year Analysis of a Nationwide Inpatient Sample.

IntroductionGastrointestinal bleeding (GIB) complicating septic shock (SS) presents a therapeutic challenge in intensive care units. Large-scale data regarding utilization, length of stay, and cost outcomes of this association are lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 2003 to 2012, and identified all adult patients aged ≥18 years hospitalized for SS by the International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code for SS and GIB. We compared the baseline characteristics and outcomes among patients with SS plus GIB to patients with SS without GIB.ResultsThe weighted sample size from 2003 to 2012 was 119,684 admissions for SS. Among them, 6,571 (5.4%) patients were found to have a GIB. The mean age of the SS population with and without GIB was (mean/standard error of mean) [70.85 (0.43) vs. 67.43 (0.13) P < 0.001, respectively]. The incidence of GIB over the course of 10 years has remained stable; however, the mortality associated with GIB among SS patients is found to be declining especially from 2008 (59.2%) to 2012 (45.1%) (P < 0.01). Patients with SS and GIB compared to patients with SS and no GIB were found to have a longer length of stay [20.56 (0.61) vs. 15.76 (0.13) P < 0.001], higher mortality [54% vs. 45% P < 0.001], and higher admission costs in United States dollar ($) (mean/SEM) [$192,524.89 (7,378.20) vs. $142,688.55 (1,336.65) P < 0.001]. Univariate analysis demonstrated that comorbid conditions like peptic ulcer disease and cirrhosis had significant odds ratios {1.56 and 1.709, P = 0.016 and 0.046 respectively} for the occurrence of GIB with SS. Gastroesophageal reflux disease was found to be associated with a lower incidence of GIB [odds ratio: 0.57, P = 0.0008]. The cause of sepsis (pneumonia, urinary tract infection, or abdominal infections) was not a significant distinguishing factor for the incidence of GIB in SS.ConclusionGIB continues to affect the patients with SS admitted in intensive care units in the United States. We found an incidence of 5.4% of GIB in patients with SS, and it was associated with worse outcomes.

Gastrointestinal Bleeding in ECMO Patients: Incidence and Outcomes

Extra corporeal membrane oxygenation (ECMO) indications and usage has remarkably progressed over the past decade. While the newer technology has improved durability compared to earlier generations, increased frequency in some complications has been seen, including gastrointestinal bleeding (GIB). We discuss the incidence and outcomes of GIB in patients receiving ECMO. From September 2014 to September 2019, 468 patients required ECMO support for different indications (VA: 302, VV: 133, Combined: 33). We retrospectively reviewed the medical records and identified 48 (10.3%) patients diagnosed with GIB after being placed on ECMO. Their pre-cannulation characteristics and outcomes were then compared to the remaining patients (no GIB group). Fisher's exact test was used to test significance in categorical variables, and t-test for continuous variables. A total of 48 patients (mean age 59±14, male 35) were diagnosed with GIB post ECMO, of those 31 patients (65%) had upper GIB, 9 (19%) had lower GIB and 3 (6%) had combined. In 5 patients (10%) bleeding was unspecified. The mean time from ECMO initiation to the presentation of the event was 11 days (±11) and ranged from same day of cannulation to up to 60 days. Thirty-one patients (65%) were in the VA ECMO group, and 8 (17%) on VV ECMO. The remaining 9 (19%) patients were in the combined ECMO group. As seen in table 1, the mean duration of ECMO support and pre- cannulation SOFA score were significantly higher in the GIB group (p < 0.01). No difference was noted on the other Parameters Furthermore, the overall hospital discharge rate showed no significant difference between both groups (p=0.95), even when considering different ECMO types (VA ECMO: p=0.32, VV ECMO: p=0.47) CONCLUSION: Our data shows that GIB is a frequent complication (10.3%) in ECMO patients. However, there was no impact on the outcomes. Further studies are required to investigate and help better understand the etiology of GIB in those patients.

Outcomes of gastrointestinal bleeding in patients with left ventricular assist devices: a tertiary care experience.

Background and study aims Left ventricular assist device (LVAD) placement is a therapeutic modality for patients with end-stage heart failure. Gastrointestinal bleeding is a common complication following LVAD implantation. The aim of this study was to report our experience in management and outcomes of gastrointestinal bleeding in a large cohort of patients with LVADs. Patients and methods We performed a retrospective review of all patients who underwent LVAD implantation at the University of Rochester Medical Center from January 2008 to June 2017. Data were collected on patient characteristics, clinical aspects of gastrointestinal bleeding events, and procedural interventions. A Cox proportional hazard model was utilized to identify potential risk factors for a gastrointestinal bleeding event. Results During the study period, 345 patients underwent LVAD implantation. Of these, 125 patients (36.2 %) experienced 297 gastrointestinal bleeding events resulting in 533 endoscopic procedures. The diagnostic yield of endoscopy in determining a bleeding source was 49.5 %. If required, therapeutic interventions were successful in achieving homeostasis in 96.2 % of procedures. Our 30-day overall post-procedure adverse event (AE) rate was 6.6 %. Procedure-related (bleeding, infection, and perforation) AEs were very minimal (2.8 %). A Cox proportional hazard model indicated that older age at implant, female sex, African-American race, diabetes mellitus, and pulmonary hypertension were statistically significant predictors of a gastrointestinal bleeding event following LVAD implantation. Conclusions LVAD patients have a high risk of gastrointestinal bleeding. Endoscopy was able to safely locate a bleeding lesion in approximately half of our patients and was successful in treating bleeding lesions in a majority of the cases.

The incidence, risk factors, and outcomes of gastrointestinal bleeding in patients with a left ventricular assist device: a Japanese single-center cohort study.

Continuous flow-left ventricular assist devices (CF-LVADs) have become a therapeutic option in the management of advanced heart failure. Several studies show that patients with CF-LVAD are at an increased risk of gastrointestinal bleeding (GIB). However, few reports have presented the characteristics of GIB in Japanese populations. We investigated the incidence, etiology, and outcome of GIB in patients with CF-LVAD. Records of adult patients who received CF-LVADs between October 2008 and January 2017 were reviewed. GIB was defined as detection of bleeding sites by any type of diagnostic imaging. 54 patients received CF-LVAD, of which eight (14%) presented with overt GIB (12 events). GIB patients are significantly older (p = 0.04) and their pre-operative inferior vena cava diameter was larger (p = 0.02). Multivariate analysis revealed that the use of Jarvik 2000 (p = 0.003) was a risk factor for GIB. In total, 85.8% of patients were free from GIB at 1year. The most common site was the small intestine (67%). The most common cause was angiodysplasia (50%). Six patients required blood transfusion (nine events) and four underwent endoscopic clippings (five events); however, no patients needed surgeries. The incidence of GIB in our cohort was similar to the global registry data. Double balloon endoscopy is useful for diagnosis and treatment of small intestinal lesions. Future efforts to further understand the incidence of GIB in Japanese populations by multicenter data are needed.

Incidence, Predictors, and Outcomes of Gastrointestinal Bleeding in Patients Admitted With ST-Elevation Myocardial Infarction

Gastrointestinal bleeding (GIB) complicating ST-elevation myocardial infarction (STEMI) poses significant management challenges and may be associated with poor outcomes. We sought to evaluate the incidence and outcomes of GIB in STEMI patients using a nationwide database. We identified adults admitted with STEMI between in the National Inpatient Sample (2003 to 2016), and compared the morbidity, mortality, resource utilization, and cost in patients with and without GIB. We assessed rates of endoscopy referral and its associated with mortality. Among 1,450,696 weighted STEMI hospitalizations, 32,624 (2.2%) were complicated with GIB. Patients with GIB were older, and had distinctive characteristics compared to those without GIB. Older age, cardiogenic shock; history of peptic ulcer disease, cirrhosis, anemia, or alcohol use disorder were the strongest predictors of GIB during STEMI hospitalizations. In-hospital mortality was higher in the GIB group (28.2% vs 11.1%, p <0.001). The excess mortality associated with GIB persisted after propensity-score matching, and in sensitivity analyses excluding patients who underwent coronary intervention >24-hours after admission, and those transferred to another hospital. Post-STEMI GIB was associated with more strokes and acute kidney injury, longer hospitalizations, and higher cost. In a logistic regression analysis, GIB was independently associated with mortality (odds ratios [OR] 1.91, 95% confidence interval [CI] 1.85 to 1.97, p <0.001). There was a correlation between undergoing endoscopy and lower in-hospital mortality (unadjusted OR 0.27; 95% CI, 0.24 to 0.29; adjusted-OR 0.30; 95% CI, 0.27 to 0.33; p <0.001). In conclusion, GIB complicating STEMI is uncommon but is associated with excess morbidity, mortality, resource utilization and cost. Referral to endoscopy in this cohort may be associated with reduced in-hospital mortality.