scholarly journals Relationship between angiography timing and angiographic visualization of extravasation in patients with acute non-variceal gastrointestinal bleeding

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chungjo Choi ◽  
Hyun Lim ◽  
Min-Jeong Kim ◽  
Bo Young Lee ◽  
Sung-Yeun Kim ◽  
...  
Keyword(s):  
Clinical Success ◽  
Angiographic Embolization ◽  
Gi Bleeding ◽  
First Line ◽  
First Line Therapy ◽  
High Maximum ◽  
Patients With Diabetes ◽  
Active Extravasation ◽  
Low Platelet Count ◽  
Short Time

Abstract Background Angiographic embolization is now considered the first-line therapy for acute gastrointestinal (GI) bleeding refractory to endoscopic therapy. The success of angiographic embolization depends on the detection of the bleeding site. This study aimed to identify the clinical and procedural predictors for the angiographic visualization of extravasation, including angiography timing, as well as analyze the outcomes of angiographic embolization according to the angiographic visualization of extravasation. Methods The clinical and procedural data of 138 consecutive patients (mean age, 66.5 years; 65.9% men) who underwent angiography with or without embolization for acute non-variceal GI bleeding between February 2008 and July 2018 were retrospectively analyzed. Results Of the 138 patients, 58 (42%) had active extravasation on initial angiography and 113 (81.9%) underwent embolization. The angiographic visualization of extravasation was significantly higher in patients with diabetes (p = 0.036), a low platelet count (p = 0.048), high maximum heart rate (p = 0.002) and AIMS65 score (p = 0.026), upper GI bleeding (p = 0.025), and short time-to-angiography (p = 0.031). The angiographic embolization was successful in all angiograms, with angiographic visualization of extravasation (100%). The clinical success of patients without angiographic visualization of extravasation (83.9%) was significantly higher than that of patients with angiographic visualization of extravasation (65.5%) (p = 0.004). In multivariate analysis, the time-to-angiography (odds ratio 0.373 [95% CI 0.154–0.903], p = 0.029) was the only significant predictor associated with the angiographic visualization of extravasation. The cutoff value of time-to-angiography was 5.0 h, with a sensitivity and specificity of 79.3% and 47.5%, respectively (p = 0.012). Conclusions Angiography timing is an important factor that is associated with the angiographic visualization of extravasation in patients with acute GI bleeding. Angiography should be performed early in the course of bleeding in critically ill patients.

Abstract 13169: US Prevalence Estimates of Individuals With Diabetes and Chronic Kidney Disease Indicated for SGLT-2 Inhibitor Initiation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rahul Aggarwal ◽  
Kimberly Lu ◽  
Nicholas Chiu ◽  
George Bakris ◽  
Deepak L Bhatt
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
The United States ◽  
Stage Iii ◽  
First Line ◽  
First Line Therapy ◽  
Urine Albumin ◽  
The Us ◽  
Patients With Diabetes

Introduction: Since the CREDENCE trial results, the American Diabetes Association (ADA) recommends SGLT-2 inhibitors as first line therapy for patients with stage III Chronic Kidney Disease (CKD) or proteinuric CKD, regardless of baseline A1C. We project the number of US individuals with diabetes and renal disease that meets inclusion into the CREDENCE trial and that are recommended for SGLT-2 inhibitors based on the guidelines. Methods: Our initial cohort consisted of 48,710 individuals from the 2007-2016 National Health and Nutrition Examination Survey with survey weights designed to estimate the US population. CREDENCE eligible patients were patients with diabetes who had an eGFR of 30-90 and urine albumin-to-creatinine ratio (UACR) of >300 mg/g. Guideline eligible patients were stage III CKD individuals and those with a UACR > 30 mg/g. Results: In the US population, 21,411,059 (+/-708,233) individuals are >=18 years and have diabetes. Of these individuals, 578,514 (+/-72,385) are CREDENCE eligible. Based on the ADA recommendations, 7,504,508 (+/- 342,139) adults with CKD and diabetes are recommended for an SGLT-2 inhibitor, representing 35.0% of individuals with diabetes. The mean age of guideline eligible individuals is 64.4 years, with 3,886,904 males (51.8%) and 3,617,604 females (48.2%). Conclusions: In the United States, a large number of individuals--approximately 35% of adults with diabetes--have renal disease characteristics that give them a first-line indication for SGLT-2 inhibitor initiation.

scholarly journals Update on RAAS Modulation for the Treatment of Diabetic Cardiovascular Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
Stella Bernardi ◽  
Andrea Michelli ◽  
Giulia Zuolo ◽  
Riccardo Candido ◽  
Bruno Fabris
Keyword(s):  
Cardiovascular Disease ◽  
Diabetic Patients ◽  
Paradigm Shifts ◽  
Angiotensin Ii Receptor ◽  
First Line ◽  
Chronic Complications ◽  
First Line Therapy ◽  
Patients With Diabetes ◽  
Receptor Blockers ◽  
Diabetic Population

Since the advent of insulin, the improvements in diabetes detection and the therapies to treat hyperglycemia have reduced the mortality of acute metabolic emergencies, such that today chronic complications are the major cause of morbidity and mortality among diabetic patients. More than half of the mortality that is seen in the diabetic population can be ascribed to cardiovascular disease (CVD), which includes not only myocardial infarction due to premature atherosclerosis but also diabetic cardiomyopathy. The importance of renin-angiotensin-aldosterone system (RAAS) antagonism in the prevention of diabetic CVD has demonstrated the key role that the RAAS plays in diabetic CVD onset and development. Today, ACE inhibitors and angiotensin II receptor blockers represent the first line therapy for primary and secondary CVD prevention in patients with diabetes. Recent research has uncovered new dimensions of the RAAS and, therefore, new potential therapeutic targets against diabetic CVD. Here we describe the timeline of paradigm shifts in RAAS understanding, how diabetes modifies the RAAS, and what new parts of the RAAS pathway could be targeted in order to achieve RAAS modulation against diabetic CVD.

SGLT-2 Inhibitors and GLP-1 Agonists: First-Line Therapy for Diabetes With Established Cardiovascular Disease

2019 ◽  
Vol 24 (5) ◽  
pp. 422-427 ◽  
Author(s):  
Aparna P. Sajja ◽  
Amit K. Dey ◽  
Avirup Guha ◽  
Youssef Elnabawi ◽  
Aditya A. Joshi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Growing Body ◽  
Patients With Diabetes ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Sodium Glucose Cotransport

There is a growing body of evidence that diabetes represents a significant and largely modifiable risk factor for cardiovascular disease (CVD). It is known to markedly increase the risk of CVD—with CVD accounting for 2 of every 3 deaths in patients with diabetes. It is suggested that once patients with diabetes develop clinical coronary disease, they have a grim prognosis. In 2008, the Food and Drug Association mandated the evidence of CV safety in any new diabetic therapy, leading to a multitude of large CV outcome trials to assess CV risk from these medications. However, several of these outcome trials with novel antidiabetic therapies have demonstrated not only safety but a clear and definite CV advantage in patients with type 2 diabetes. In this review, we discuss 2 relatively newer classes of diabetic drugs, sodium glucose cotransport 2 inhibitors and glucagon-like peptide 1 agonists, evaluate their efficacy in improving CV outcomes, and discuss the future of CV prevention with these agents.

scholarly journals Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials

2019 ◽  
Vol 07 (11) ◽  
pp. E1563-E1573 ◽  
Author(s):  
Corey S. Miller ◽  
Alan N. Barkun ◽  
Myriam Martel ◽  
Yen-I Chen
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Randomized Trials ◽  
Clinical Success ◽  
Meta Analysis ◽  
Malignant Biliary Obstruction ◽  
First Line ◽  
First Line Therapy ◽  
Catheter Dysfunction ◽  
Distal Malignant Biliary Obstruction

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is increasingly used for distal malignant biliary obstruction, yet its safety and efficacy compared to endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) remain unclear. We performed a meta-analysis to improve our understanding of the role of EUS-BD in this patient population. Methods We searched Embase, MEDLINE, CENTRAL, and ISI Web of Knowledge through September 2018 for randomized controlled trials (RCTs) comparing EUS-BD to ERCP-BD or PTBD as treatment of distal malignant biliary obstruction. Risk ratios (RRs) with 95 % confidence intervals (CIs) were combined using random effects models. The primary outcome was risk of stent/catheter dysfunction requiring reintervention. Results Of six trials identified, three (n = 222) compared EUS-BD to ERCP-BD for first-line therapy; three others (n = 132) evaluated EUS-BD versus PTBD after failed ERCP-BD. EUS-BD was associated with a decreased risk of stent/catheter dysfunction overall (RR, 0.39; 95 %CI 0.27 – 0.57) and in planned subgroup analysis when compared to ERCP (RR, 0.41; 95 %CI 0.23 – 0.74) or PTBD (RR, 0.37, 95 %CI 0.22 – 0.61). Compared to ERCP, EUS was associated with a decreased risk of post-procedure pancreatitis (RR, 0.12; 95 %CI 0.01 – 0.97). No differences were noted in technical or clinical success. Conclusions In a meta-analysis of randomized trials comparing EUS-BD to conventional biliary drainage modalities, no difference in technical or clinical success was observed. Importantly, EUS-BD was associated with decreased risks of stent/catheter dysfunction when compared to both PTBD and ERCP, and decreased post-procedure pancreatitis when compared to ERCP, suggesting the potential role for EUS-BD as an alternative first-line therapy in distal malignant biliary obstruction.

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