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Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists.

Fortinsky KJ, Martel M, Razik R, Spiegle G, Gallinger ZR, Grover SC, Pavenski K, Weizman AV, Kwapisz L, Mehta S, Gray S, Barkun AN - Can J Gastroenterol Hepatol (2016)

Bottom Line: Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) were transfused more liberally than healthy patients.Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.

ABSTRACT
Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB). Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds. Results. The response rate was 41% (N = 203). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L; p < 0.001). Many clinicians (24%) reported transfusing a hemodynamically unstable patient at a Hgb threshold of 100 g/L and the majority (57%) are transfusing two units of RBCs as initial management. Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) were transfused more liberally than healthy patients. Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge. Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB.

No MeSH data available.


Related in: MedlinePlus

Are clinicians transfusing patients with UGIB on novel anticoagulants more liberally than patients on warfarin?
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fig3: Are clinicians transfusing patients with UGIB on novel anticoagulants more liberally than patients on warfarin?

Mentions: Patients with coronary artery disease (mean Hgb 84.0 g/L versus 71.0 g/L, p < 0.001) or cirrhosis (mean Hgb 74.4 g/L versus 71.0 g/L, p < 0.01) were transfused at higher threshold hemoglobin than healthy patients, as were patients on warfarin (mean Hgb of 75.3 g/L versus 71.0 g/L, p < 0.001). 15% (95% CI) of respondents would perform transfusion more liberally if the patients were on dabigatran, rivaroxaban, or apixaban as opposed to warfarin (see Figure 3). Overall, hemodynamically unstable patients were transfused more liberally than hemodynamically stable patients across all scenarios (see Figure 4). For a healthy hemodynamically unstable patient (see survey scenarios in Section 2.2, Scenario  2) 19%, 1%, and 3% (95% CI) of clinicians would perform transfusion at hemoglobin threshold of 100 g/L, 110 g/L, and 120 g/L, respectively.


Red Blood Cell Transfusions and Iron Therapy for Patients Presenting with Acute Upper Gastrointestinal Bleeding: A Survey of Canadian Gastroenterologists and Hepatologists.

Fortinsky KJ, Martel M, Razik R, Spiegle G, Gallinger ZR, Grover SC, Pavenski K, Weizman AV, Kwapisz L, Mehta S, Gray S, Barkun AN - Can J Gastroenterol Hepatol (2016)

Are clinicians transfusing patients with UGIB on novel anticoagulants more liberally than patients on warfarin?
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940523&req=5

fig3: Are clinicians transfusing patients with UGIB on novel anticoagulants more liberally than patients on warfarin?
Mentions: Patients with coronary artery disease (mean Hgb 84.0 g/L versus 71.0 g/L, p < 0.001) or cirrhosis (mean Hgb 74.4 g/L versus 71.0 g/L, p < 0.01) were transfused at higher threshold hemoglobin than healthy patients, as were patients on warfarin (mean Hgb of 75.3 g/L versus 71.0 g/L, p < 0.001). 15% (95% CI) of respondents would perform transfusion more liberally if the patients were on dabigatran, rivaroxaban, or apixaban as opposed to warfarin (see Figure 3). Overall, hemodynamically unstable patients were transfused more liberally than hemodynamically stable patients across all scenarios (see Figure 4). For a healthy hemodynamically unstable patient (see survey scenarios in Section 2.2, Scenario  2) 19%, 1%, and 3% (95% CI) of clinicians would perform transfusion at hemoglobin threshold of 100 g/L, 110 g/L, and 120 g/L, respectively.

Bottom Line: Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) were transfused more liberally than healthy patients.Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.

ABSTRACT
Introduction. There is limited data evaluating physician transfusion practices in patients with acute upper gastrointestinal bleeding (UGIB). Methods. A web-based survey was sent to 500 gastroenterologists and hepatologists across Canada. The survey included clinical vignettes where physicians were asked to choose transfusion thresholds. Results. The response rate was 41% (N = 203). The reported hemoglobin (Hgb) transfusion trigger differed by up to 50 g/L. Transfusions were more liberal in hemodynamically unstable patients compared to stable patients (mean Hgb of 86.7 g/L versus 71.0 g/L; p < 0.001). Many clinicians (24%) reported transfusing a hemodynamically unstable patient at a Hgb threshold of 100 g/L and the majority (57%) are transfusing two units of RBCs as initial management. Patients with coronary artery disease (mean Hgb of 84.0 g/L versus 71.0 g/L; p < 0.01) or cirrhosis (mean Hgb of 74.4 g/L versus 71.0 g/L; p < 0.01) were transfused more liberally than healthy patients. Fewer than 15% would prescribe iron to patients with UGIB who are anemic upon discharge. Conclusions. The transfusion practices of gastroenterologists in the management of UGIB vary widely and more high-quality evidence is needed to help assess the efficacy and safety of selected transfusion thresholds in varying patients presenting with UGIB.

No MeSH data available.


Related in: MedlinePlus