Preprocedural Hemoglobin Research Articles

Increased Intrauterine Transfusion Blood Volume Needed to Correct Fetal Anemia due to Placental Chorioangioma

Introduction: To compare the blood volume transfused for fetal anemia in cases of placental chorioangioma versus red blood cell (RBC) alloimmunization in patients matched for gestational age (GA) and hydrops. Methods: Study patients had intrauterine transfusions and were obtained from 3 sources: group (1) placental chorioangioma patients treated at our center (2016–2023); group (2) placental chorioangioma patients reported in the medical literature; and group (3) RBC alloimmunization patients treated for fetal anemia at our center (2016–2023) matched (2:1) to patients in groups 1 and 2 by GA at procedure and presence of hydrops. The expected volume (cc) of transfusion was calculated for all patients based on a formula commonly used for fetal anemia in cases of RBC alloimmunization that includes the GA at procedure, pre-transfusion hemoglobin, donor hemoglobin, and target hemoglobin. The ratio of the volume actually transfused to the expected volume was calculated for each group and for groups 1 and 2 combined; comparisons were made using nonparametric testing. Results: By group, the patients studied included: (1) 7 treated chorioangioma patients, (2) 8 chorioangioma patients described in the literature, and (3) 30 matched RBC alloimmunization patients. The median (range) GA at procedure for groups 1, 2, and 3 was 29.6 (22.7–32.7), 27.0 (24.0–30.0), 28.4 (22.7–34.3) weeks. The median pre-procedure hemoglobin for each group was 8.5 (5.8–12.5), 6.7 (5.6–12.0), and 5.3 (2.2–10.7) g/dL, and the median post-procedure hemoglobin for each group was 12.9 (11.5–14.0), 12.7 (9.6–14.7), and 13.6 (8.0–15.7) g/dL. The median (range) ratio of the actual to the expected volume transfused for each group was 2.50 (1.79–8.33), 1.64 (1.11–3.85), and 1.10 (0.69–1.86) (p < 0.001). When groups 1 and 2 were combined, the median ratio was 1.89 (1.11–8.33), which remained statistically significant when compared to group 3 (p < 0.001). Conclusion: Intrauterine transfusion for fetal anemia in cases of large placental chorioangiomas appeared to require nearly twice the blood volume that was normally anticipated for cases of RBC alloimmunization, although the actual amount transfused varied widely.

Evaluation of contrast induced nephropathy related risk factors and long-term results.

We aimed to evaluate the frequency of contrast induced nephropathy (CIN), its relationship with accepted risk factors and long-term renal outcomes in patients who underwent coronary angiography (CAG). All patients who underwent CAG between April 2020 and April 2021 were retrospectively evaluated. CIN was defined as characteristic increase in serum creatinine after CAG. CIN developed in 50 (5.4%) of 934 patients. The CIN rate was found to be statistically significantly higher in patients with diabetes, hypertension, heart failure and those using diuretics. Pre-procedural hemoglobin, albumin and GFR were found to be independent risk factors for CIN. After discharge, the urea and creatinine values of the patients who developed CIN were significantly higher than those who did not. We concluded that in order to reduce the development of CIN, hemoglobin and albumin levels should be evaluated with renal functions before the procedure and they should be kept within normal limits.

Predicting Major Adverse Events in Patients Undergoing Transcatheter Left Atrial Appendage Occlusion.

The National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry (LAAO) includes the vast majority of transcatheter LAAO procedures performed in the United States. The objective of this study was to develop a model predicting adverse events among patients undergoing LAAO with Watchman FLX. Data from 41 001 LAAO procedures with Watchman FLX from July 2020 to September 2021 were used to develop and validate a model predicting in-hospital major adverse events. Randomly selected development (70%, n=28 530) and validation (30%, n=12 471) cohorts were analyzed with 1000 bootstrapped samples, using forward stepwise logistic regression to create the final model. A simplified bedside risk score was also developed using this model. Increased age, female sex, low preprocedure hemoglobin, no prior attempt at atrial fibrillation termination, and increased fall risk most strongly predicted in-hospital major adverse events and were included in the final model along with other clinically relevant variables. The median in-hospital risk-standardized adverse event rate was 1.50% (range, 1.03%-2.84%; interquartile range, 1.42%-1.64%). The model demonstrated moderate discrimination (development C-index, 0.67 [95% CI, 0.65-0.70] and validation C-index, 0.66 [95% CI, 0.62-0.70]) with good calibration. The simplified risk score was well calibrated with risk of in-hospital major adverse events ranging from 0.26% to 3.90% for a score of 0 to 8, respectively. A transcatheter LAAO risk model using National Cardiovascular Data Registry and LAAO Registry data can predict in-hospital major adverse events, demonstrated consistency across hospitals and can be used for quality improvement efforts. A simple bedside risk score was similarly predictive and may inform shared decision-making.

Management and clinical outcomes for patients with gastrointestinal bleeding who decline transfusion.

The national blood shortage and growing patient population who decline blood transfusions have created the need for bloodless medicine initiatives. This case series describes the management of gastrointestinal bleed patients who declined allogeneic blood transfusion. Understanding the effectiveness of bloodless techniques may improve treatment for future patients while avoiding the risks and cost associated with transfusion. A retrospective chart review identified 30 inpatient encounters admitted between 2016 to 2022 for gastrointestinal hemorrhage who declined transfusion due to religious or personal reasons. Clinical characteristics and patient blood management methods utilized during hospitalization were analyzed. Hemoglobin concentrations and clinical outcomes are reported. The most common therapy was intravenous iron (n = 25, 83.3%), followed by erythropoietin (n = 18, 60.0%). Endoscopy was the most common procedure performed (n = 23, 76.7%), and surgical intervention was less common (n = 4, 13.3%). Pre-procedure hemoglobin was <6 g/dL in 7 patients, and <5 g/dL in 4 patients. The median nadir hemoglobin was 5.6 (IQR 4.5, 7.0) g/dL, which increased post-treatment to 7.3 (IQR 6.2, 8.4) g/dL upon discharge. One patient (3.3%) with a nadir Hb of 3.7 g/dL died during hospitalization from sepsis. Nine other patients with nadir Hb <5 g/dL survived hospitalization. Gastrointestinal bleed patients can be successfully managed with optimal bloodless medicine techniques. Even patients with a nadir Hb <5-6 g/dL can be stabilized with aggressive anemia treatment and may safely undergo anesthesia and endoscopy or surgery for diagnostic or therapeutic purposes. Methods used for treating bloodless medicine patients may be used to improve clinical care for all patients.

A new index for predicting malignant causes in patients with extrahepatic biliary obstruction: the hemoglobin, albumin, lymphocyte, and platelet (HALP) score.

The study aimed to investigate whether the pre-procedural hemoglobin, albumin, lymphocyte, and platelet (HALP) scores can distinguish between benign and malignant causes of obstruction in patients who undergo endoscopic retrograde cholangiopancreatography (ERCP) for extrahepatic biliary obstruction (EBO). The HALP scores of the patients were calculated according to the values before ERCP. The patients were divided into two groups as malignant and benign according to their diagnosis after ERCP. The HALP scores, demographic characteristics, and some laboratory data of the groups were compared. The cut-off values of the HALP scores were found to detect malignant obstructive causes using the receiver operating characteristic (ROC) curve analysis. A total of 295 patients had benign and 50 had malignant causes of obstruction among the total of 345 patients. The HALP score was found to be lower in the patient group with malignant biliary obstruction (p = 0.013). The ROC curve analysis was used to determine the diagnostic efficiency, and an area under the curve (AUC) of 0.610 was obtained (0.526-0.693, 95% CI) (p = 0.013). For the HALP score, the sensitivity was found to be 82.4% and the specificity was 30% when a cut-off value of <12.54 was used, and the sensitivity was 61.4% and specificity was 52% when the cut-off value was <21.25. The study showed that a low HALP score can distinguish malignant causes in patients with EBO. We think that the HALP score, which is a low-cost index that can be easily calculated with simple tests, can be used in this patient population because it may allow early diagnosis of malignant causes in patients with EBO.

Machine learning prediction model of acute kidney injury after percutaneous coronary intervention

Acute kidney injury (AKI) after percutaneous coronary intervention (PCI) is associated with a significant risk of morbidity and mortality. The traditional risk model provided by the National Cardiovascular Data Registry (NCDR) is useful for predicting the preprocedural risk of AKI, although the scoring system requires a number of clinical contents. We sought to examine whether machine learning (ML) techniques could predict AKI with fewer NCDR-AKI risk model variables within a comparable PCI database in Japan. We evaluated 19,222 consecutive patients undergoing PCI between 2008 and 2019 in a Japanese multicenter registry. AKI was defined as an absolute or a relative increase in serum creatinine of 0.3 mg/dL or 50%. The data were split into training (N = 16,644; 2008–2017) and testing datasets (N = 2578; 2017–2019). The area under the curve (AUC) was calculated using the light gradient boosting model (GBM) with selected variables by Lasso and SHapley Additive exPlanations (SHAP) methods among 12 traditional variables, excluding the use of an intra-aortic balloon pump, since its use was considered operator-dependent. The incidence of AKI was 9.4% in the cohort. Lasso and SHAP methods demonstrated that seven variables (age, eGFR, preprocedural hemoglobin, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction/unstable angina, heart failure symptoms, and cardiogenic shock) were pertinent. AUC calculated by the light GBM with seven variables had a performance similar to that of the conventional logistic regression prediction model that included 12 variables (light GBM, AUC [training/testing datasets]: 0.779/0.772; logistic regression, AUC [training/testing datasets]: 0.797/0.755). The AKI risk model after PCI using ML enabled adequate risk quantification with fewer variables. ML techniques may aid in enhancing the international use of validated risk models.

Baseline mean platelet volume is a strong predictor of major and life-threatening bleedings after transcatheter aortic valve replacement

Bleeding following transcatheter aortic valve replacement (TAVR) has important prognostic implications. This study sought to evaluate the impact of baseline mean platelet volume (MPV), a routinely used marker of platelet reactivity, on bleeding events in a contemporary real-world TAVR cohort. Patients undergoing TAVR between February 2010 and May 2019 with available preprocedural MPV were included. Low MPV (L-MPV) was defined as MPV ≤ 10 fL and high MPV (H-MPV) as MPV > 10 fL. The primary endpoint was the occurrence of major/life-threatening bleeding complications (MLBCs) at one year follow-up. Among 1,111 patients, 398 (35.8%) had L-MPV and 713 (64.2%) had H-MPV. The rate of MLBCs at 1 year was higher in L-MPV patients compared with H-MPV patients (22.9% vs. 17.7% respectively, P = 0.034). L-MPV was associated with vascular access-site complications (36.2% vs. 28.9%, P = 0.012), early (< 30 days) major bleeding (15.6% vs. 9.4%, P < 0.01) and red blood cell transfusion > 2 units (23.9% vs. 17.5%, P = 0.01). No impact of baseline MPV on overall death, cardiovascular death and ischemic events (myocardial infarction and stroke) was evidenced. Multivariate analysis using Fine and Gray model identified preprocedural hemoglobin (sHR 0.84, CI95% [0.75–0.93], P = 0.001), preprocedural L-MPV (sHR 1.64, CI95% [1.16–2.32], P = 0.005) and CT-ADP post-TAVR (sHR 2.71, CI95% [1.87–3.94], P < 0.001) as predictors of MLBCs (Fig. 1, Table 1). Preprocedural MPV was identified as an independent predictor of MLBCs one year after TAVR, regardless of the extent of platelet inhibition and primary hemostasis disorders. MPV should be regarded as a simple, common and valuable biomarker of bleeding prediction after TAVR.

Initial experience and early outcomes of the management of acute pulmonary embolism using the FlowTriever mechanical thrombectomy device.

Submassive and massive pulmonary embolism is associated with a high risk of complications. We aimed to evaluate our initial experience with a mechanical thrombectomy device in the management of these patients. A single-center, retrospective study was performed in patients with acute submassive and massive pulmonary embolism treated with the FlowTriever device (Inari Medical, Irvine, CA, USA) between June 2019 and November 2020. Clinical and technical parameters were analyzed during the hospitalization and at 30- and 180-days after the procedure. Fourteen patients were evaluated with a median (IQR) age of 60 (50-69) years and 64% were male. All had right heart strain as the main indication for thrombectomy. The procedure duration and fluoroscopic time was 52 (37-89) and 13 (9-24) minutes, respectively. There was 100% technical success, and the pulmonary arterial pressure went from 60 (48-65) mmHg to 40 (34-47) mmHg. Thrombolysis was used in two patients and nine patients required intensive care. 100% experienced improvement in symptoms at the time of discharge. There were no device-related complications, major bleeding events, myocardial infarctions, or deaths. Preprocedural hemoglobin was 13 (12-15) g/dL, and predischarge was 12 (10-13) g/dL. Overall postprocedural length of stay was three (2-6) days. All the patients were discharged with oral anticoagulation. There were no device-related complications or recurrence of embolism at 30 and 180 days. The mechanical thrombectomy device for submassive and massive pulmonary embolism is promising and appears a safe and effective procedure with 100% technical success, no complications, short intensive care requirement/stay, and good early clinical outcomes.

Are Transmetatarsal Amputations a Durable Limb Salvage Option? A Single-Institution Descriptive Analysis

In limb and life-threatening diabetic foot infections, transmetatarsal amputations are often indicated as a limb salvage procedure. The aim of this study is to analyze the long-term durability of initially successful transmetatarsal amputations in the diabetic population. We defined a successful transmetatarsal amputation as one which had clinical healing 1 year after surgery. A retrospective review of transmetatarsal amputations completed at our institution over an 11-year period was performed. We identified 83 amputations that met inclusion criteria. The mean follow-up was 4 years. The mean time to surgical healing was 109.8 days. After successfully healing the transmetatarsal amputation the long-term outcomes were analyzed. Re-ulcerations occurred in 44% of the transmetatarsal amputations a mean of 15 months after surgical healing. Patients who re-ulcerated were noted to be significantly younger (p value 0.02) with a significantly higher preprocedure hemoglobin A1c (p value < .001). Additional procedures after successful healing included 13 (15.66%) revision surgeries and 12 (14.46%) more proximal amputations. While transmetatarsal amputations remain a viable and durable limb preserving surgery, all patients who have undergone a transmetatarsal amputation should be monitored lifelong as they remain at risk for re-ulceration and more proximal amputation.

Development and validation of a predictive model for bleeding after peripheral vascular intervention: A report from the National Cardiovascular Data Registry Peripheral Vascular Interventions Registry.

To develop a model to predict risk of in-hospital bleeding following endovascular peripheral vascular intervention. Peri-procedural bleeding is a common, potentially preventable complication of catheter-based peripheral vascular procedures and is associated with increased mortality. We used the National Cardiovascular Data Registry (NCDR) Peripheral Vascular Interventions (PVI) Registry to develop a novel risk-prediction model to identify patients who may derive the greatest benefit from application of strategies to prevent bleeding. We examined all patients undergoing lower extremity PVI at 76 NCDR PVI hospitals from 2014 to 2017. Patients with acute limb ischemia (n=1600) were excluded. Major bleeding was defined as overt bleeding with a hemoglobin (Hb) drop of ≥ 3g/dl, any Hb decline of ≥ 4g/dl, or a blood transfusion in patients with pre-procedure Hb ≥ 8g/dl. Hierarchical multivariable logistic regression was used to develop a risk model to predict major bleeding. Model validation was performed using 1000 bootstrapped replicates of the population after sampling with replacement. Among 25,382 eligible patients, 1017 (4.0%) developed major bleeding. Predictors of bleeding included age, female sex, critical limb ischemia, non-femoral access, prior heart failure, and pre-procedure hemoglobin. The model demonstrated good discrimination (optimism corrected c-statistic=0.67), calibration (corrected slope=0.98, intercept of -0.04) and range of predicted risk (1%-18%). Post-procedural PVI bleeding risk can be predicted based upon pre- and peri-procedural patient characteristics. Further studies are needed to determine whether this model can be utilized to improve procedural safety through developing and targeting bleeding avoidance strategies.

The prognostic implications of chronic kidney disease and anemia on long-term outcomes in patients undergoing percutaneous coronary intervention.

Chronic kidney disease (CKD) and anemia are each individually associated with worse clinical outcomes in patients with coronary artery disease (CAD). However, the prognostic impact of both CKD and anemia on clinical outcomes, when they coexist, remains unclear in CAD patients after percutaneous coronary intervention (PCI). We studied 2484 CAD patients who underwent their first PCI and had available date on preprocedural hemoglobin between 2000 and 2016. The patients were divided into four groups according to the presence of CKD and/or anemia. We evaluated the incidences of all-cause death and major adverse cardiac and cerebrovascular events (MACCEs), including cardiovascular death, non-fatal myocardial infarction, and stroke. Among the patients, 310 patients (12.5%) had both CKD and anemia (CKD with anemia group), 309 (12.4%) had CKD only, 461(18.6%) had anemia only, and 1404 (56.5%) had neither CKD nor anemia. Patients in the CKD with anemia group were older and had a higher incidence of hypertension and diabetes mellitus. During a median follow-up period of 3.7years, Kaplan-Meier curves showed that patients in the CKD with anemia group had significantly higher incidences of MACCE and all-cause death than the CKD only and anemia only group (both log-rank p < 0.001). Using patients with the no CKD or anemia group as a reference, the adjusted hazard ratios (HRs), 95% confidence interval for MACCE were 1.51 (0.92-2.47) for the CKD only, 1.48 (0.94-2.32) for the anemia only and 2.00 (1.18-3.38) for the CKD with anemia group. Moreover, the adjusted HR for all-cause death were 1.42 (0.96-2.10) for the CKD only, 1.79 (1.28-2.51) for the anemia only, and 1.92 (1.30-2.84) for the CKD with anemia group. In conclusion, the combined effects of both CKD and anemia on outcomes after PCI were worse than either of their individual effects.

Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN-TAVI registry.

To assess the impact of anemia on clinical outcomes in female patients enrolled in the Women's InterNational transcatheter aortic valve implantation (WIN-TAVI) registry. Anemia is highly prevalent among females who constitute half of TAVI candidates, yet, its clinical significance remains poorly investigated. Patients were divided into three groups according to preprocedural hemoglobin (Hb) level: (1) no anemia (Hb ≥12 g/dl), (2) mild-to-moderate anemia (10 ≤ Hb <12 g/dl), and (3) severe anemia (Hb <10 g/dl). The primary outcome was the occurrence of Valve Academic Research Consortium (VARC)-2 efficacy endpoint, a composite of mortality, stroke, myocardial infarction (MI), hospitalization for valve-related symptoms or heart failure or valve-related dysfunction at 1-year follow-up. Hemoglobin level was available in 877 (86.1%) patients: 412 (47.0%) had no anemia, 363 (41.4%) had mild-to-moderate anemia, and 102 (11.6%) had severe anemia. The latter group had a higher prevalence of cardiovascular risk factors. Compared with patients without anemia, severe anemia was associated with a greater risk of VARC-2 efficacy endpoint (adj HR 1.71, 95% CI: 1.02-2.87, p = .04), all-cause death (adj HR 2.36, 95% CI: 1.31-4.26, p = .004) and a composite of death, MI or stroke (adj HR 1.88, 95% CI: 1.10-3.22, p = .02) at 1 year. Moreover, an increased risk of late mortality (adj HR 1.15, 95% CI: 1.02-1.30, p = .03) was observed with every 1 g/dl decrease in hemoglobin level. Severe anemia in females undergoing TAVI was independently associated with increased rates of VARC-2 efficacy endpoint and mortality at 1 year.

Partial Splenic Artery Embolization for Idiopathic Warm Autoimmune Hemolytic Anemia Refractory to Medical Therapy

Purpose: While Partial Splenic Artery Embolization (PSAE) is a useful procedure that has been performed for a variety of indications including trauma and hypersplenism, it has only been rarely described as a treatment for Idiopathic Warm Autoimmune Hemolytic Anemia. Previous reports in the literature are limited to case reports in situations that include the patient being a poor surgical candidate, the inability to transfuse blood during surgery because of autoantibodies, and a patient's refusal of blood products on religious grounds. Materials and Methods: A case report describing the case of a 27-year-old male diagnosed with idiopathic warm Autoimmune Hemolytic Anemia treated successfully with partial splenic artery embolization (PSAE) as a bridging therapy to definitive surgical splenectomy. Results: The patient's pre-procedure hemoglobin was 2.1 g/dl. The first hemoglobin post-procedure was 4.5 g/dl. After embolization, the patient remained in the inpatient setting for eight days for close observation. During the inpatient hospitalization the patient's hemoglobin continued to trend upwards until it stabilized around 6 g/dl. Inpatient laboratory workup also showed increasing haptoglobin, and decreasing LDH. After discharge, the patient developed persistent pain two months post-procedure. An elective splenectomy was scheduled three months after the embolization procedure to address the persistent pain. Six months' post embolization procedure and three months postoperatively, the patient is doing well clinically with a hemoglobin of 14 g/dl. Conclusion: In conclusion, this case demonstrates the utility of a Partial Splenic Artery Embolization (PSAE) as an acute life-saving intervention for poor surgical candidates with idiopathic warm Autoimmune Hemolytic Anemia (AIHA) refractory to medical therapy.

Influence of preprocedural glycemic control on clinical outcomes of endovascular therapy in diabetic patients with lower extremity artery disease: an analysis from a Korean multicenter retrospective registry cohort

BackgroundThe influence of intensive glucose control in diabetic patients on the macrovascular outcomes is controversial. Thus, this study aimed to elucidate the effect of preprocedural hemoglobin A1c (HbA1c) on clinical outcomes after endovascular therapy for lower extremity artery disease (LEAD) in diabetic patients.MethodsDiabetic patients were enrolled from the retrospective cohorts of a Korean multicenter endovascular therapy registry and were divided according to the HbA1c level during index admission into the optimal (< 7.0%) or suboptimal (≥ 7.0%) glycemic control groups. The primary endpoints were major adverse limb events (MALE, a composite of major amputation, minor amputation, and reintervention).ResultsOf the 1103 patients enrolled (897 men, mean age 68.2 ± 8.9 years), 432 (39.2%) were classified into the optimal glycemic control group and 671 (60.8%) into the suboptimal glycemic control group. In-hospital events and immediate procedural complications were not different between the two groups. The suboptimal group showed a trend towards a higher incidence of MALE than the optimal group (log-rank p = 0.072). Although no significant differences were found between the two groups in terms of overall survival or amputation, the risk of reintervention was significantly higher in the suboptimal group (log-rank p = 0.048). In the multivariate Cox regression model, suboptimal glycemic control was one of the independent predictors for reintervention. When our data were analyzed according to the initial presentation, suboptimal preprocedural HbA1c significantly increased the incidence of MALE compared with optimal preprocedural HbA1c only in patients with intermittent claudication.ConclusionIn diabetic patients undergoing endovascular therapy for LEAD, suboptimal preprocedural HbA1c is associated with an increased risk of adverse limb events, especially in patients with intermittent claudication. Further prospective research will be required to validate the role of more intensive glycemic control on the reduction of adverse limb events in diabetic patients undergoing endovascular therapy for LEAD.

Tu1078 DOES THROMBOCYTOPENIA PREDICT POOR OUTCOME AFTER ENDOSCOPY FOR EVALUATION OF GRAFT-VERSUS-HOST DISEASE IN HEMATOLOGIC CANCER PATIENTS WITH ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT?

Graft-versus-host disease (GVHD) is the most common life-threatening complication of allogeneic hematopoietic stem cell transplant (HSCT) with the GI tract being a commonly involved site. Current guidelines recommend a platelet count of at least 50x103/μL and absolute neutrophil count (ANC) of 500 cells/μL to mitigate bleeding and infection risk, however this is based on limited data. Given that patients with hematologic malignancies who have undergone HSCT are prone to severe cytopenias, we aim to determine whether severe thrombocytopenia or neutropenia predict poor outcome in this population. We identified 159 endoscopies (upper endoscopy, flexible sigmoidoscopy, colonoscopy) from our institutional database performed on patients who underwent HSCT for hematologic malignancies to evaluate for GVHD. A multiple logistic regression was performed to determine whether pre-procedure platelet count above 50x103/μL, pre-procedure hemoglobin, and pre-procedure ANC predict adverse outcome (bleeding/infection within 1 week or death within 1 month of endoscopy) while controlling for age, sex, pathological diagnosis of GVHD, and days since HCST. 159 endoscopies were performed on patients with mean age 53+16 years, 53.5% women, and median 96 (28-327) days since HCST. The most common diagnoses were AML 55/159 (34.6%), B-ALL 30/159 (18.9%), and CML 14/159 (8.8%). Diarrhea 105/159 (66.0%), nausea/vomiting 63/159 (39.6%), and abdominal pain 31/159 (19.5%) were the most common indications for evaluation of GVHD. Abnormal pathology was most frequently found in the stomach 74/159 (46.5%), duodenum 66/159 (41.5%), and sigmoid colon 54/159 (34.0%). The majority of patients were on tacrolimus 101/159 (63.5%), sirolimus 70/159 (44.0%), and hydrocortisone 59/159 (37.1%) immunosuppression. Bleeding occurred following 5/159 (3.1%) endoscopies, with successful hemostasis in all cases. Death within 1 month of endoscopy occurred in 7/159 (4.4%). A pre-procedure platelet count above 50x103/μL (OR, 0.24; 95% CI, 0.06-0.94; P=0.04) and increased pre-procedure hemoglobin (OR, 0.54; 95% CI, 0.33-0.88; P=0.01) were associated with decreased odds of adverse outcome following endoscopy. Although a platelet cutoff above 50x103/μL was associated with lower odds of adverse events post-endoscopy, the overall risk of endoscopic procedures was low. In our series, under 4% of endoscopic interventions resulted in bleeding, infection, or fever. As expected, patients with higher pre-procedure hemoglobin conferred a decreased risk of adverse events. Pre-procedure ANC was not significantly associated with adverse outcome. Further characterization of safety at different platelet thresholds is necessary to inform the decision to proceed with endoscopy in this at-risk population.

2986 Celiac Disease Among Hispanics Undergoing EGD for Workup of Unexplained Anemia in a Safety Net Population

INTRODUCTION: Celiac disease (CD) affects roughly 1% of the population globally and 0.75% of the general US population. In individuals with confirmed iron deficiency anemia (IDA), the prevalence of CD is much higher, with nearly 4% of such individuals affected in large cohort studies. The prevalence of CD in Hispanics however remains largely unknown due to over representation of non-Hispanic whites in the studies. We aimed to examine the prevalence of CD in Hispanics with unexplained anemia and in those with confirmed IDA presenting to a large safety net health care system. METHODS: Electronic health records of all Hispanic patients (self-identified) referred for workup of unexplained anemia at our institution from 8/2013 to 4/2018 were retrospectively analyzed. Data were collected with regards to comorbidities, pre-procedure hemoglobin, and pre-procedure ferritin. All patients underwent EGD with duodenal biopsies from both the first and second portion of the duodenum as part of routine workup for unexplained anemia. Anemia was defined using the established World Health Organization criteria (hemoglobin &lt;12 g/d for women, &lt;13 g/dL for men). Pathology reports were reviewed for biopsy proven CD utilizing the Marsh classification system. Subgroup analysis of patients with confirmed IDA (ferritin &lt;15 ng/mL) was also performed. Mean hemoglobin and ferritin were calculated in all patients. In those with biopsy confirmed CD, a mean Marsh classification score was also determined. Means and standard deviations were calculated for all continuous variables to better characterize our population cohort. RESULTS: 96 Hispanic patients with unexplained anemia were identified; 36 were male; average age 53.9. In our patient cohort peptic ulcer disease 14.4% (14/96) and malignancy 6.2% (6/96), were most common identified etiologies of anemia. There were 5 cases of biopsy proven CD with an overall prevalence of 5.2% (5/96). Prevalence of CD among patients with confirmed IDA was 2.4% (1/41) (Table 1). At the time of diagnosis average Marsh score was 3 for all patients and for patients with IDA. CONCLUSION: Our data from large safety net health care system shows high rate CD among Hispanics with unexplained anemia suggesting the continued utility of screening for CD in work up of unexplained anemia in Hispanic patient population.

P3736Predictors of access site complication in transfemoral transcatheter aortic valve implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is an increasing common treatment option for patients (pts) with symptomatic severe aortic stenosis (AS). Despite its proven effectiveness and decreasing complication rate, vascular access site complications still occur in 5–7% of the cases and are associated with increased mortality and morbidity. Purpose The aim of this study was to analyze pts with vascular complications during TAVI procedure to better understand underlying mechanisms and aid future risk stratification. Methods From our ongoing single center TAVI registry encompassing over 1600 pts, we recruited 200 pts with vascular complications. By using propensity score 1:2 matching 400 controls without vascular complications were identified. Matching was done for peripheral vascular disease, age, gender, sheath size and BMI using the nearest neighbor algorithm. In the femoral artery, a localized, upward calcium scoring over 10 cm starting from the bifurcation was conducted in all pts using the 3mensio structural heart software ver. 8.0 (Pie Medical Imaging BV). Comparison between groups was done using the t-test. Multiple regression analysis was used to identify risk factors independently associated with vascular complication. Results Using VARC-2 definitions 22 (11%) pts classified as major and 178 (89%) as minor vascular complications. Patients with vascular complications had a significantly longer duration of hospitalization 17.1 days vs. 14.4 days (p=0.001), were more often on oral anticoagulation in 22.3% vs. 15.1%, (p=0.03) and had low preprocedural hemoglobin (11.8 vs. 12.1 (p=0.03). Vascular complications resulted in significantly higher 30 day mortality (7.4% vs. 3.2%, p=0.02). Detailed analysis of the femoro-iliacal vessels showed a higher percentage of kinking (50.5% vs. 33%, p = &lt;0.001) in pts with vascular complications, however the calcium score was not significantly different (269.57 vs. 267.18, p=0.94). Of interest, pts with major vascular complications had a significantly higher calcium score as compared to controls (500.3 vs. 267.2, p=0.002). Major complications also translated in an even higher mortality after 30 days (18.2% vs. 3.2% (p = &lt;0.001) and hospitalization time (days): 27.7 vs. 14.5 (p = &lt;0.001) Multiple regression analysis identified vascular kinking (p = &lt;0.001) and oral anticoagulation (p=0.04) at admission to be independent risk factors for vascular complication in the overall cohort whereas calcium score was only predictive for major vascular complications (p=0.04) Conclusion This study confirms that vascular complications during TAVI are associated with increased 30 day mortality and longer hospitalization. Patient dependent factors are the main predictors for vascular complications and should be considered thoroughly.

TCT-159 Clinical Significance of Elevated Preprocedural Hemoglobin Level as a Marker of Outcomes After Percutaneous Coronary Intervention

Background: Adverse effects have been reported in patients with preprocedural anemia after percutaneous coronary intervention (PCI), but data regarding the relationship between elevated hemoglobin ...

Relation of Preprocedural Hemoglobin Level to Outcomes After Percutaneous Coronary Intervention

Adverse effects have been reported in patients with preprocedural anemia after percutaneous coronary intervention (PCI), but data regarding the relation between elevated hemoglobin (Hb) level and post-PCI prognosis remain limited. This study assessed the impact of elevated Hb on major adverse cardiac and cerebrovascular event (MACCE) at 12 months, a composite of all-cause mortality, nonfatal myocardial infarction, and ischemic stroke after PCI. We pooled patient-level data from four Korean multicenter drug-eluting stent registries from 2010 to 2016. In total, 5,107 patients were divided into 5 categories according to the baseline Hb level (<10, 10 to 12.9, 13 to 14.9, 15 to 16.9 and ≥17 g/dl). Patients with higher Hb levels were significantly younger, predominantly male, current smokers with higher body mass index, and more frequent dyslipidemia. Hypertension, diabetes, chronic kidney disease, and cerebrovascular accident were more prevalent in lower Hb groups. Categorically, a U-shaped curvilinear relation was observed between baseline Hb and clinical outcomes showing significantly higher MACCE rate in <10g/dl (hazard ratio [HR], 4.62 [2.81 to 7.68]) and ≥17 g/dl (HR, 4.06 [1.57 to 10.5]) groups compared with the reference group (13 to 14.9 g/dl), especially in men. In nonanemic patients (Hb ≥13 g/dl), adjusted HRs of MACCE, mortality, and stroke were significantly higher in ≥17 g/dl group than in the reference group. Furthermore, ≥17 g/dl was an independent predictor for MACCE and all-cause mortality after PCI. In conclusion, not only low Hb but also elevated Hb of ≥17 g/dl was significantly associated with higher MACCE rates and all-cause mortality after PCI. An appropriate treatment strategy for patients with high Hb level should be identified through future studies.

Efficacy and safety of radiofrequency ablation for treatment of chronic radiation proctitis: A systematic review and meta-analysis.

Although argon plasma coagulation is the current standard endoscopic treatment for chronic radiation proctitis (CRP), radiofrequency ablation (RFA) has emerged as an attractive alternative. The aim of this study is to evaluate the efficacy and safety of RFA for the treatment of CRP. Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed from 2004 through March 2018. Review and data abstraction were performed independently by two authors. Measured outcomes included hemoglobin, transfusion dependence, number of treatment sessions, RFA settings, and serious adverse events. Six studies (n=71; mean age 73.41±1.88years; 90.14% male) were included. Thirty-eight percent of patients failed prior treatment with argon plasma coagulation. Patients underwent a mean of 1.71±0.34 RFA sessions with 24.54±16.47 RFA applications per session. Pooled clinical and endoscopic success of RFA was 99% (95% confidence interval [CI]: 90-100; P<0.001) and 100% (95% CI: 94-100; P<0.001), respectively. Serious adverse events were reported in one patient-pooled rate of 0% (95% CI: 0-3; P<0.001). Mean pre-procedure hemoglobin was 10.38±1.82g/dL with significant improvement observed post-RFA [weighted mean difference 2.49g/dL (95% CI: 2.16-2.82; P<0.001)]. Among transfusion-dependent patients, 85% (95% CI: 68-97; P<0.001) became transfusion-free post-RFA. Pooled mean follow-up was 19.73±9.72months. Despite limited long-term data on RFA for CRP, available evidence suggests RFA is an effective and safe treatment.