Poster Session C - Monday Afternoon
Category: GI Bleeding
Pedro Cortes, MD
Mayo Clinic
Jacksonville, FL
Baseline Characteristics Median (IQR) or Fraction (%) | Unadjusted Cox Regression For Recurrent GI Bleeding | ||
| All Patients N=100 | HR (95% CI) | p-value |
Age at Coronary Stent Placement, per 1 year | 70.5 (61.7-77.8) | 1.00 (0.75-1.34) | 1.00 |
Male gender | 74 (74.0%) | 0.76 (0.38-1.51) | 0.43 |
White Race | 100 (100%) | NA | NA |
Hispanic Ethnicity | 1 (1.0%) | NA | NA |
Never Smoker | 32 (32.0%) | 0.52 (0.24-1.16) | 0.1093 |
Body Mass Index, per 1 kg/m2 | 30.0 (26.4-30.4) | 1.00 (0.95-1.05) | 0.91 |
Obesity | 50 (50.0%) | 1.23 (0.64-2.38) | 0.53 |
Comorbidities – defined as per HAS-BLED |
|
|
|
Hypertension | 91 (91.0%) | 0.70 (0.25-1.98) | 0.50 |
Chronic Kidney Disease | 15 (15.0%) | 2.04 (0.91-4.57) | 0.0823 |
Liver Disease | 15 (15.0%) | 1.39 (0.57-3.37) | 0.47 |
History of stroke | 12 (12.0%) | 0.85 (0.30-2.42) | 0.77 |
Prior Major Bleeding (before LHC) | 28 (28.0%) | 2.82 (1.45-5.49) | 0.0023 |
Labile INR | 29 (29.0%) | 2.75 (1.43-5.30) | 0.0025 |
Age > 65 | 66 (66.0%) | 1.64 (0.77-3.50) | 0.20 |
Medication predisposing to bleeding | 100 (100.0%) | NA | NA |
Alcohol use | 26 (26.0%) | 1.14 (0.53-2.42) | 0.74 |
HAS-BLED score | 4 (3-5) | 1.46 (1.16-1.84) | 0.0014 |
· HAS-BLED > 3 | 53 (53.0%) | 2.87 (1.41-6.17) | 0.0041 |
Coronary Catheterization Data |
|
|
|
Pre-catheterization Endoscopy Performed | 12 (12.0%) | 1.59 (0.62-4.12) | 0.34 |
· Delay in LHC due to endoscopy | 1 (8.3%) | NA | NA |
Indication for coronary catheterization |
|
|
|
· Acute Coronary Syndrome | 65 (65.0%) | 2.29 (1.07-4.92) | 0.0332 |
o NSTEMI | 41 (41.0%) | 1.07 (0.55-2.07) | 0.85 |
o STEMI | 24 (24.0%) | 2.52 (1.24-5.12) | 0.0110 |
· Stable CAD | 35 (35.0%) | 0.44 (0.20-0.94) | 0.0332 |
Number of Stents Placed, per 1 stent | 2 (1-2) | 1.23 (0.87-1.75) | 0.24 |
· 3 or more stents placed | 20 (20.0%0 | 1.45 (0.66-3.20) | 0.36 |
Hemoglobin prior to catheterization, per 1 g/dL | 12.70 (10.5-14.2) | 0.90 (0.78-1.03) | 0.13 |
Medications After Catheterization |
|
|
|
Proton pump inhibitor | 31 (31.0%) | 0.74 (0.35-1.57) | 0.43 |
SSRI | 12 (12.0%) | 1.29 (0.50-3.31) | 0.60 |
NSAIDs | 2 (2.0%) | NA | NA |
Anticoagulation | 42 (42.0%) | 1.24 (0.64-2.38) | 0.53 |
· Warfarin | 27 (27.0%) | 1.92 (0.63-5.88) | 0.25 |
· DOAC | 14 (14.0%) | 0.57 (0.19-1.74) | 0.33 |
Indication for Anticoagulation |
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|
|
· Atrial Fibrillation | 33 (33.0%) | 1.92 (0.44-8.39) | 0.38 |
· DVT/PE | 6 (6.0%) | 0.90 (0.21-3.93) | 0.89 |
Initial Episode of Gastrointestinal Bleed (GIB) |
|
|
|
Median time to Index GIB, days | 166 (22.8-374.8) | NA | NA |
P2Y12 inhibitor taken prior to admission | 89 (89.0%) | 1.21 (0.43-3.42) | 0.72 |
Presenting sign |
|
|
|
· None | 10 (10.0%) | 1.10 (0.39-3.13) | 0.86 |
· Hematemesis | 11 (11.0%) | 0.77 (0.23-2.50) | 0.66 |
· Melena | 50 (25.0%) | 0.67 (0.35-1.30) | 0.24 |
· Hematochezia | 32 (32.0%) | 1.00 (0.50-2.01) | 0.99 |
Labs at time of GIB |
|
|
|
· Hemoglobin, per 1 g/dL | 8.4 (6.7-10.1) | 0.87 (0.75-1.00) | 0.0506 |
o Hemoglobin drop, per 1 g/dL | 3.8 (2.7-5.5) | 1.03 (0.90-1.18) | 0.65 |
· Platelets, per 50 x 109/L | 207 (167.8-272.8) | 1.25 (1.07-1.46) | 0.005 |
· INR, per 1 point | 1.2 (1.1-1.9) | 1.14 (0.95-1.36) | 0.15 |
Endoscopy Performed | 81 (81.0%) |
|
|
· Inpatient Procedure | 74/81 (91.4%) | 1.45 (0.34-6.12) | 0.61 |
· Normal endoscopy | 9/81 (11.1%) | 1.67 (0.58-4.82) | 0.34 |
· Esophageal varices | 0 | NA | NA |
· Esophagitis | 10/81 (12.4%) | 1.67 (0.57-4.87) | 0.35 |
· Gastritis | 11/81 (13.6%) | 1.67 (0.68-4.11) | 0.26 |
· Ulcerations | 33/81 (40.7%) | 0.78 (0.36-1.67) | 0.52 |
Source of Bleeding Found |
|
|
|
· Unknown | 26 (32.1%) | 1.23 (0.58-2.61) | 0.59 |
Intervention Performed | 34/81 (42.0%) | 0.63 (0.29-1.35) | 0.23 |
Number of pRBCs transfused, per 1 unit | 1 (0-3) | 1.14 (1.01-1.30) | 0.0453 |
Transfer to ICU during hospitalization | 21 (21.0%) | 1.17 (0.51-2.68) | 0.71 |
Severe GIB | 26(26.0%) | 1.49 (0.73-3.04) | 0.27 |
P2Y12 Inhibitor Discontinued due to GIB | 19/100 (19.0%) | 0.56 (0.73-3.04) | 0.27 |
Endpoint |
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|
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Recurrence of GI Bleeding | 36/100 (36.0%) | NA | NA |
· Median time to recurrent GIB, days | 53.5 (14.8-121.5) | NA | NA |