Outcomes of endoscopic intervention for overt GI bleeding in severe thrombocytopenia

Ramos, Guilherme Piovezani; Binder, Moritz; Hampel, Paul J.; Neto, Manuel Bonfim Braga; Sunjaya, Dharma; Bawardy, Badr Al; Dayyeh, Barham K. Abu; Buttar, Navtej; Prabhu-Coelho, Nayantara; Larson, Mark V.; Song, Louis M. Wong Kee; Rajan, Elizabeth

doi:10.1016/j.gie.2018.01.028

Cited by 18 publications

(14 citation statements)

References 22 publications

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“…This provides gastroenterologists with a broader range of platelet count regarding endoscopy and safety concerns, compared with the previously reported cut-off of 50 Â 10 3 /mL. 22,24,25 These previous studies had small patient sample size, which could have limited their power. In addition, some studies did not assess the risk of bleeding according to ASGE risk stratification.…”

Section: Discussionmentioning

confidence: 96%

Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

Abu-Sbeih

Ali

Coronel

et al. 2019

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 96%

Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

Abu-Sbeih

Ali

Coronel

et al. 2019

Gastrointestinal Endoscopy

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“…An increased international normalized ratio (INR) >2, however, was a predictor of recurrent bleeding. 61 Portal Hypertensive Gastropathy Portal hypertensive gastropathy (PHG) is common among patients with cirrhosis and is the second most common cause of non-variceal GI bleeding. Its prevalence has been reported to range from 11% to 98%.…”

Section: Non-variceal Gastrointestinal Bleedingmentioning

confidence: 99%

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Sigal¹,

Sherman

Jesudian

2020

HMER

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Thrombocytopenia is a frequent complication in patients with cirrhosis. As many as 84% of patients with cirrhosis have thrombocytopenia, and it is an independent variable indicative of advanced disease and poor prognosis. Although there is great concern that it may aggravate bleeding during surgical procedures, there is limited evidence to inform decisions regarding the treatment of cirrhotic patients with thrombocytopenia undergoing invasive procedures. Finally, there is evidence that platelets play a significant role in liver regeneration. In this report, the clinical implications of thrombocytopenia in cirrhotic patients are reviewed. The utility of platelet counts in the prognosis of cirrhosis and relationship to complications of advanced liver disease, including portal hypertension, esophageal varices, and hepatocellular carcinoma. The impact of low platelet counts on bleeding complications during invasive procedures is outlined. Finally, the role of platelets and potential adverse impact in liver regeneration is reviewed.

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“…Consistently, our studies reported that the INR and PT of severe patients were statistically higher than in mild patients. Compared with the thrombocytopenia frequently seen in populations with liver cirrhosis and hematologic malignancies, platelets in the severe group were not signi cantly different from the mild group, whereas platelets in the moderate group were signi cantly higher than in the mild group [20][21][22].…”

Section: Discussionmentioning

confidence: 57%

Impact of Anemia on the Outcomes of Endoscopic Intervention in High-Risk NUGIB Patients

Tan

Lan

Bai

et al. 2020

Preprint

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Background: It is common for high-risk, non-variceal upper gastrointestinal bleeding (NUGIB) patients coexisting anemia, but the role of anemia on the prognosis of endoscopic intervention is not clear. The aim of this study was to assess the impact of hemoglobin level on outcomes of endoscopic intervention in high-risk NUGIB patients. Methods: A retrospective study was performed on high-risk (Glasgow-Blatchford score ≥7) NUGIB patients who underwent endoscopic intervention within 24h of presentation. Patients were divided into three groups based on hemoglobin level before intervention: severe (<7g/dl), moderate (7g/dl ≤hemoglobin <9g/dl) and mild (≥9g/dl) group. Outcomes included mortality, length of ICU stay, re-bleeding rate, procedural adverse events, length of hospital stay, adverse events and transfusion requirement. Results: A total of 156 patients received endoscopic intervention were identified, 88 in the severe group, 45 in the moderate group, and 23 in the mild group. The total mortality rate in 45 days was 2%, and the re-bleeding rate was 21%. There was no significant difference in mortality, re-bleeding rate or length of ICU stay among the three groups. The average days of hospitalization in the severe group was significantly longer than that of the moderate group (13 vs 8, P < 0.05). No adverse events occurred. Low hemoglobin level was a predictor for more red-cell transfusion (OR=5.94, 2.69-13.11) and plasma transfusion (OR=2.34,1.21-4.51). Conclusions: Anemia does not affect the mortality and rebleeding of endoscopic intervention in high-risk NUGIB patients, but is associated with more transfusion and longer hospitalization.

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Outcomes of endoscopic intervention for overt GI bleeding in severe thrombocytopenia

Cited by 18 publications

References 22 publications

Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Impact of Anemia on the Outcomes of Endoscopic Intervention in High-Risk NUGIB Patients

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Outcomes of endoscopic intervention for overt GI bleeding in severe thrombocytopenia

Cited by 18 publications

References 22 publications

Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

<p>Clinical Implications of Thrombocytopenia for the Cirrhotic Patient</p>

Impact of Anemia on the Outcomes of Endoscopic Intervention in&nbsp;High-Risk NUGIB Patients

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Impact of Anemia on the Outcomes of Endoscopic Intervention in High-Risk NUGIB Patients