Effect of Transfusion Strategy in Acute Non‐variceal Upper Gastrointestinal Bleeding: A Nationwide Study of 5861 Hospital Admissions in Denmark

Fabricius, Rasmus; Svenningsen, Peter; Hillingsø, Jens; Svendsen, Lars Bo; Sillesen, Martin

doi:10.1007/s00268-015-3370-4

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…A retrospective nationwide survey of 5861 hospital admissions in Denmark showed that the number of units of red blood cells is a predictor of the need for repeated endoscopy, surgery and 30-day mortality. 19 In Canada, a retrospective cohort of 1677 patients with UGIB found that transfusion of red blood cells within 24 hours of presentation was significantly and independently associated with an increased risk of recurrent bleeding. 20 Another retrospective cohort from Australia, which included 2228 patients with NVUGIB, also reported that blood transfusion of more than four units is associated with increased risk of further bleeding, but not with higher mortality.…”

Section: Consensus Statementsmentioning

confidence: 99%

Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Sung

Chiu

Chan

et al. 2018

Gut

225

210

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Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

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Section: Consensus Statementsmentioning

confidence: 99%

Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Sung

Chiu

Chan

et al. 2018

Gut

225

210

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show abstract

“…Limitations of FFP include the requirement for a higher volume load to achieve a reversal effect, slower onset of action compared with PCC, and requirement for blood group typing. In addition, recent evidence suggests that use of FFP is associated with increased mortality in patients undergoing endoscopy for NVUGIH [56][57][58]. Three-or four-factor PCC or FFP can be used when the reversal of anticoagulation is urgent because of patient hemodynamic instability or life-threatening massive bleeding, irrespective of INR values.…”

Section: Recommendationmentioning

confidence: 99%

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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MAIN RECOMMENDATIONS 1 ESGE recommends in patients with acute upper gastrointestinal hemorrhage (UGIH) the use of the Glasgow–Blatchford Score (GBS) for pre-endoscopy risk stratification. Patients with GBS ≤ 1 are at very low risk of rebleeding, mortality within 30 days, or needing hospital-based intervention and can be safely managed as outpatients with outpatient endoscopy.Strong recommendation, moderate quality evidence. 2 ESGE recommends that in patients with acute UGIH who are taking low-dose aspirin as monotherapy for secondary cardiovascular prophylaxis, aspirin should not be interrupted. If for any reason it is interrupted, aspirin should be re-started as soon as possible, preferably within 3–5 days.Strong recommendation, moderate quality evidence. 3 ESGE recommends that following hemodynamic resuscitation, early (≤ 24 hours) upper gastrointestinal (GI) endoscopy should be performed. Strong recommendation, high quality evidence. 4 ESGE does not recommend urgent (≤ 12 hours) upper GI endoscopy since as compared to early endoscopy, patient outcomes are not improved. Strong recommendation, high quality evidence. 5 ESGE recommends for patients with actively bleeding ulcers (FIa, FIb), combination therapy using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical therapy). Strong recommendation, high quality evidence. 6 ESGE recommends for patients with an ulcer with a nonbleeding visible vessel (FIIa), contact or noncontact thermal therapy, mechanical therapy, or injection of a sclerosing agent, each as monotherapy or in combination with epinephrine injection. Strong recommendation, high quality evidence. 7 ESGE suggests that in patients with persistent bleeding refractory to standard hemostasis modalities, the use of a topical hemostatic spray/powder or cap-mounted clip should be considered. Weak recommendation, low quality evidence. 8 ESGE recommends that for patients with clinical evidence of recurrent peptic ulcer hemorrhage, use of a cap-mounted clip should be considered. In the case of failure of this second attempt at endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE. Strong recommendation, moderate quality evidence. 9 ESGE recommends high dose proton pump inhibitor (PPI) therapy for patients who receive endoscopic hemostasis and for patients with FIIb ulcer stigmata (adherent clot) not treated endoscopically. (a) PPI therapy should be administered as an intravenous bolus followed by continuous infusion (e. g., 80 mg then 8 mg/hour) for 72 hours post endoscopy. (b) High dose PPI therapies given as intravenous bolus dosing (twice-daily) or in oral formulation (twice-daily) can be considered as alternative regimens.Strong recommendation, high quality evidence. 10 ESGE recommends that in patients who require ongoing anticoagulation therapy following acute NVUGIH (e. g., peptic ulcer hemorrhage), anticoagulation should be resumed as soon as the bleeding has been controlled, preferably within or soon after 7 days of the bleeding event, based on thromboembolic risk. The rapid onset of action of direct oral anticoagulants (DOACS), as compared to vitamin K antagonists (VKAs), must be considered in this context.Strong recommendation, low quality evidence.

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“…A retrospective cohort study by Fabricius et al . 29 in 2016 showed that the risk of a second endoscopy increased by 8% and the risk of death within 30 days increased by approximately 4% whenever one unit of red blood was transfused. A subgroup analysis by Subramaniam et al .…”

Section: Bodymentioning

confidence: 99%

Guidelines for Nonvariceal Upper Gastrointestinal Bleeding

Kim

et al. 2020

Gut and Liver

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Nonvariceal upper gastrointestinal bleeding (NVUGIB) refers to bleeding that develops in the gastrointestinal tract proximal to the ligament of Treitz. NVUGIB requires hospitalization and is associated with significant morbidity and mortality. Although European and Asian-Pacific guidelines have been published, there have been no previous guidelines regarding management of NVUGIB in Korea. Korea has a high prevalence of Helicobacter pylori infections, and patients have easy accessibility to endoscopy. Therefore, we believe that guidelines regarding management of NVUGIB in Korea are essential. The Korean Society of Gastroenterology reviewed the recent evidence and recommends practical management guidelines on NVUGIB in Korea.

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Effect of Transfusion Strategy in Acute Non‐variceal Upper Gastrointestinal Bleeding: A Nationwide Study of 5861 Hospital Admissions in Denmark

Abstract: PRBC transfusion was associated with adverse events, including 30-day mortality and failure of hemostasis. In contrast, transfusion of PLT was associated with a reduction in need for re-endoscopy.

Cited by 8 publications

References 18 publications

Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Guidelines for Nonvariceal Upper Gastrointestinal Bleeding

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