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Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding

OBJECTIVES: Evaluate clinical outcomes in transarterial embolisation (TAE) for acute gastrointestinal bleeding (GIB) and determine risk factors for 30-day reintervention for rebleeding and mortality. METHODS: TAE cases were retrospectively reviewed between March 2010 and September 2020 at our tertia...

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Autores principales: Delf, Jonathan, Ramachandran, Sanjeev, Martin, Christopher A, Vadera, Sonam, Mustafa, Syed, Waters, Kate, Saeed, Abdullah, Adair, William, Glasby, Michael, Kandiyil, Neghal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Institute of Radiology. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10078864/
https://www.ncbi.nlm.nih.gov/pubmed/36802859
http://dx.doi.org/10.1259/bjr.20211351
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author Delf, Jonathan
Ramachandran, Sanjeev
Martin, Christopher A
Vadera, Sonam
Mustafa, Syed
Waters, Kate
Saeed, Abdullah
Adair, William
Glasby, Michael
Kandiyil, Neghal
author_facet Delf, Jonathan
Ramachandran, Sanjeev
Martin, Christopher A
Vadera, Sonam
Mustafa, Syed
Waters, Kate
Saeed, Abdullah
Adair, William
Glasby, Michael
Kandiyil, Neghal
author_sort Delf, Jonathan
collection PubMed
description OBJECTIVES: Evaluate clinical outcomes in transarterial embolisation (TAE) for acute gastrointestinal bleeding (GIB) and determine risk factors for 30-day reintervention for rebleeding and mortality. METHODS: TAE cases were retrospectively reviewed between March 2010 and September 2020 at our tertiary centre. Technical success (angiographic haemostasis following embolisation) was measured. Uni- and multivariate logistic regression analysis were performed to identify risk factors for clinical success (absence of 30-day reintervention or mortality) following embolisation for active GIB or empirical embolisation for suspected bleeding. RESULTS: TAE was conducted in 139 patients (92 (66.2%) male; median age:73, range: 20–95 years) for acute upper GIB (n = 88) and lower GIB (n = 51). TAE was technically successful in 85/90 (94.4%) and clinically successful in 99/139 (71.2%); with 12 (8.6%) reintervention cases for rebleeding (median interval 2 days) and 31 (22.3%) cases of mortality (median interval 6 days). Reintervention for rebleeding was associated with haemoglobin drop > 40 g l(−1) from baseline based on univariate analysis (p = 0.047). 30-day mortality was associated with pre-intervention platelet count < 150×10(9) l(−1) (p < 0.001, OR 7.35, 95% CI 3.05–17.71) and INR > 1.4 (p < 0.001, OR 4.75, 95% CI 2.03–11.09) on multivariate logistic regression analysis. No associations were found for patient age, gender, antiplatelet/anticoagulation prior to TAE, or when comparing upper and lower GIB with 30-day mortality. CONCLUSION: TAE had excellent technical success for GIB with relatively high (1-in-5) 30-day mortality. INR > 1.4 and platelet count < 150×10(9) l(−1) were individually associated with TAE 30-day mortality, and pre-TAE > 40 g l(−1) haemoglobin decline with rebleeding requiring reintervention. ADVANCES IN KNOWLEDGE: Recognition and timely reversal of haematological risk factors may improve TAE periprocedural clinical outcomes.
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spelling pubmed-100788642023-04-07 Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding Delf, Jonathan Ramachandran, Sanjeev Martin, Christopher A Vadera, Sonam Mustafa, Syed Waters, Kate Saeed, Abdullah Adair, William Glasby, Michael Kandiyil, Neghal Br J Radiol Full Paper OBJECTIVES: Evaluate clinical outcomes in transarterial embolisation (TAE) for acute gastrointestinal bleeding (GIB) and determine risk factors for 30-day reintervention for rebleeding and mortality. METHODS: TAE cases were retrospectively reviewed between March 2010 and September 2020 at our tertiary centre. Technical success (angiographic haemostasis following embolisation) was measured. Uni- and multivariate logistic regression analysis were performed to identify risk factors for clinical success (absence of 30-day reintervention or mortality) following embolisation for active GIB or empirical embolisation for suspected bleeding. RESULTS: TAE was conducted in 139 patients (92 (66.2%) male; median age:73, range: 20–95 years) for acute upper GIB (n = 88) and lower GIB (n = 51). TAE was technically successful in 85/90 (94.4%) and clinically successful in 99/139 (71.2%); with 12 (8.6%) reintervention cases for rebleeding (median interval 2 days) and 31 (22.3%) cases of mortality (median interval 6 days). Reintervention for rebleeding was associated with haemoglobin drop > 40 g l(−1) from baseline based on univariate analysis (p = 0.047). 30-day mortality was associated with pre-intervention platelet count < 150×10(9) l(−1) (p < 0.001, OR 7.35, 95% CI 3.05–17.71) and INR > 1.4 (p < 0.001, OR 4.75, 95% CI 2.03–11.09) on multivariate logistic regression analysis. No associations were found for patient age, gender, antiplatelet/anticoagulation prior to TAE, or when comparing upper and lower GIB with 30-day mortality. CONCLUSION: TAE had excellent technical success for GIB with relatively high (1-in-5) 30-day mortality. INR > 1.4 and platelet count < 150×10(9) l(−1) were individually associated with TAE 30-day mortality, and pre-TAE > 40 g l(−1) haemoglobin decline with rebleeding requiring reintervention. ADVANCES IN KNOWLEDGE: Recognition and timely reversal of haematological risk factors may improve TAE periprocedural clinical outcomes. The British Institute of Radiology. 2023-04-01 2023-03-03 /pmc/articles/PMC10078864/ /pubmed/36802859 http://dx.doi.org/10.1259/bjr.20211351 Text en © 2023 The Authors. Published by the British Institute of Radiology https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 Unported License http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) , which permits unrestricted non-commercial reuse, provided the original author and source are credited.
spellingShingle Full Paper
Delf, Jonathan
Ramachandran, Sanjeev
Martin, Christopher A
Vadera, Sonam
Mustafa, Syed
Waters, Kate
Saeed, Abdullah
Adair, William
Glasby, Michael
Kandiyil, Neghal
Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding
title Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding
title_full Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding
title_fullStr Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding
title_full_unstemmed Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding
title_short Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding
title_sort haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding
topic Full Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10078864/
https://www.ncbi.nlm.nih.gov/pubmed/36802859
http://dx.doi.org/10.1259/bjr.20211351
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