P1525 - Glasgow Blatchford Score and AIMS65 Predict the Need for Blood Transfusion in Patients With Non-Variceal Upper Gastrointestinal Bleed on Dual Anti-Platelet Therapy

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Rahul Karna, MD

Maulana Azad Medical College
Pittsburgh, PA, United States

Rahul Karna, MD, Bandhul Hans, MD, Dhruv Chaudhary, MD, Manish Dhawan, MD
Allegheny Health Network, Pittsburgh, PA

Introduction: Dual antiplatelet therapy (DAPT) is a well-known risk factor for non-variceal upper gastrointestinal bleed (NVUGIB). Existing scoring systems for UGIB have not been validated to predict need for transfusions and rebleeding risk in patients on DAPT.

Methods: A retrospective chart review was done for all consecutive adult patients between 2015-2020 who presented with NVUGIB on DAPT (aspirin, clopidogrel; aspirin, ticagrelor; aspirin, prasugrel) to Allegheny Health Network and underwent EGD. Patients who had DAPT held prior to EGD as per ASGE guidelines were excluded from the study. An exploratory analysis was done to assess predictive ability of four GI bleeding risk scores [Glasgow Blatchford score (GBS), AIMS65, qSOFA and Rockall] for the need of blood transfusion and rebleeding events after hemostasis. Logistic regression was used to identify variables independently associated with the need of blood transfusion and rebleeding events and odds ratios and 95% CI were computed. P value < 0.05 was considered as the level of significance.

Results: 75 patients including 53 males & 22 females met inclusion criteria for final analysis. 44/75(58.7%) patients received blood transfusions. Median number of blood units per patient was 1(IQR 3; range 0 – 21 units). GBS and AIMS65 score could predict the need for blood transfusion (Table 1A). Sensitivity, specificity, PPV, NPV and accuracy of GBS and AIMS 65 to predict the need for transfusion is presented in Table 1B. 17/75 (22.7%) patients experienced rebleeding after achieving primary hemostasis. None of the four scoring system reached statistical significance to predict rebleeding (Table 1A).

Discussion: More than fifty percent of patient population required blood transfusion. GBS and AIMS65 were originally developed to risk stratify and predict mortality in patients with UGIB. Our study shows predictive ability of GBS and AIMS 65 for the need of blood transfusion. This may help the timely planning and allocation of resources, especially in resource-constrained regions. However, the study needs to be validated in a larger study population before it can be used in clinical practice.

Table 1A	N	Odds Ratio	95% Confidence Interval	P-value	N	Odds Ratio	95% Confidence Interval	P-value
Blood transfusion					Re-bleeding
GBS	74	1.32	1.11 – 1.56	.002	74	.952	.816 – 1.112	.537
AIMS65	74	2.77	1.38 – 5.53	.004	74	.515	.247 – 1.073	.077
qSOFA	75	1.28	.70 – 2.32	.421	75	.478	.190 – 1.201	.116
Rockall score	74	.82	.63 – 1.1	.122	74	.949	.705 – 1.278	.731

Table 1B	Sensitivity	Specificity	PPV	NPV	Accuracy
Blood transfusion
GBS	88.4%	48.4%	70.4%	75.0%	71.6%
AIMS65	95.3%	25.8%	64.1%	80.0%	66.2%

Table: Table 1: (A) Gastrointestinal bleeding risk scores as predictors of blood transfusion and re-bleeding. (B) Performance of bleeding risk scores as predictor of transfusion.
Abbreviations: GBS: Glasgow-Blatchford score, qSOFA: quick sequential organ failure assessment, PPV: positive predictive value, NPV: negative predictive value

Disclosures:

Rahul Karna indicated no relevant financial relationships.

Bandhul Hans indicated no relevant financial relationships.

Dhruv Chaudhary indicated no relevant financial relationships.

Manish Dhawan indicated no relevant financial relationships.

Rahul Karna, MD, Bandhul Hans, MD, Dhruv Chaudhary, MD, Manish Dhawan, MD. P1525 - Glasgow Blatchford Score and AIMS65 Predict the Need for Blood Transfusion in Patients With Non-Variceal Upper Gastrointestinal Bleed on Dual Anti-Platelet Therapy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.