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• W2978909875 abstract "Introduction: Thrombocytopenia is often noted in populations at higher risk for gastrointestinal bleeding (GIB) and raises concerns about endoscopic procedure risk. The study aims were to assess the efficacy and safety of endoscopy for overt GIB in cirrhotic and non-cirrhotic patients in the setting of severe thrombocytopenia (ST). Methods: This was a retrospective study of patients who underwent inpatient endoscopy within 24 hours of presentation for acute GIB with a pre-procedure platelet count (PC) < 50X10E9/L. Primary outcomes measured were number of packed red blood cell (pRBC) and platelet transfusions, length of hospital stay, and re-bleeding rates at 1-month and 1-year post-procedure. Secondary endpoints were all-cause and GIB-related mortality at 1-month and 1-year post-procedure. Results: A total of 185 patients (36% women) with median age of 59 years (range 19-92) were identifi ed. The majority of patients presented with melena (42%) and hematemesis (38%). Cirrhosis (56%) and malignancy (26%) were the most common etiologies of ST. The median pre-procedure PC was 40x10E9/L (range 4-49). A total of 208 endoscopies (167 upper and 41 lower) were performed. Active bleeding or high-risk bleeding stigmata with endoscopic hemostasis was recorded in 59% of patients. The most common lesions were esophageal varices (22%), gastric/duodenal ulcers (16%) and angiodysplasias (10%). The most common therapy was variceal banding (40%). One procedure (0.4%) was complicated by perforation and death. The median number of pRBC (2 vs. 1, p < 0.001) and platelet (1 vs. 0, p < 0.001) transfusions significantly decreased after endoscopic hemostasis. Median hospital stay was significantly shorter following endoscopic hemostasis (6 vs.10 days, p=0.006). Re-bleeding rates at 1-month (22% vs. 25%, p=0.72) and 1-year (28% vs. 31%, p=0.62), and GIB-related mortality at 1-month (6% vs. 3%, p =0.47) and 1-year (6% vs. 3%, p=0.31) were similar between groups (with and without endoscopic hemostasis). There was no significant difference in outcomes when comparing cirrhotic and non-cirrhotic patients. Predictors of mortality were INR>2, aPTT>38 s and ICU admission. Conclusion: Endoscopy for GIB is relatively safe and should not be deterred in the setting of ST, in both cirrhotic and non-cirrhotic patients. Endoscopic hemostasis was associated with a decrease in pRBC and platelet transfusions and length of hospital stay, without differences in re-bleeding and mortality rates." @default.
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• W2978909875 date "2016-10-01" @default.
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• W2978909875 title "Outcomes of Endoscopic Intervention for Gastrointestinal Bleeding in the Setting of Severe Thrombocytopenia" @default.
• W2978909875 doi "https://doi.org/10.14309/00000434-201610001-00360" @default.
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