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HEFT EMCAST UPPER GI BLEEDS; WHAT’S YOUR THRESHOLD?

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Presentation on theme: "HEFT EMCAST UPPER GI BLEEDS; WHAT’S YOUR THRESHOLD?"— Presentation transcript:

1 HEFT EMCAST UPPER GI BLEEDS; WHAT’S YOUR THRESHOLD?

2 GUIDELINES The British Society of Gastroenterology guidelines on Acute GI bleeding recommends the use of the Blatchford Score for Risk stratifying patients; Score of 0 equates to low risk Score of ≥1 equates to high risk

3 THE BLATCHFORD SCORE Systolic blood pressure Urea Comrobidities/other markers Haemoglobin

4 Risk markerAssociated score Systolic BP (mmHg) < 903 Urea ≥6.5 <8.02 ≥8.0 <10.03 ≥10.0 <25.04 ≥256 Comorbidities/other markers Pulse ≥ 100 bpm1 Presenting with malaena1 Presenting with syncope1 Hepatic disease2 Cardiac failure2 Haemoglobin (g/dl) men ≥12.0 <13.01 ≥10.0 <12.03 <10.06 Haemoglobin (g/dl) women ≥10.0 <12.01 <10.06

5 THE PAPER Transfusion strategies for acute upper gastrointestinal bleeding N Engl J Med. 2013

6 SCORE Blatchford score of 0 equates to low risk Approx 25% of ED patients are low risk British society for gastroenterology recommends; ‘for those with significant bleeding, early endoscopy plays a central role in management’ SIGN guideline UGIB - recommends endoscopy within 24 hours of presentation SIGN guideline UGIB

7 INCLUSION CRITERIA >18 years of age Experiencing either haematemesis (NG bloody aspirate), malaena or both as confirmed by hospital staff

8 EXCLUSION CRITERIA Patients declining to undergo transfusion Masive exsanguinating bleeding ACS Lower GI bleeding Rockall score of 0 with an HB of > 12 g/dl And others…….

9 INTERVENTION Restrictive strategy (RS) Threshold for transfusion was 7 g per dl Target of transfusion 7 – 9 g per dl Liberal-strategy (LS) Threshold for transfusion 9 g per dl Target range for transfusion of 9-11 g per dl

10 OUTCOMES Primary mortality within 45 days Secondary Further bleeding In hospital complications

11 RESULTS Primary outcome – mortality at 45 days RS 5% LS 9% p value 0.02

12 RESULTS Secondary outcomes Rate of further bleeding (after adjustment for baseline risk factors) lower in the RS Hazard ratio % CI Complication rate RS 40% LS 48%

13 REFERNECES British Society of Gastroenterology guidelines on Acute GI bleeding Villanueva, C., Colomo, A., Bosch, A., Concepción, M., Hernandez-Gea, V., Aracil, C. et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013; 368: 11–21


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