2808 Gastrointestinal Bleeding After Pancreatic Transplant, Beyond the Usual Suspects: A Systematic Review

Abstract Background and study aims TC-325 is a novel mineral hemostatic powder that creates a mechanical barrier by absorbing blood components and promoting clotting. Recently approved for use in humans, it has shown promise for treatment of upper gastrointestinal bleeding (UGIB). However, because there have been no large studies of TC-325, its true efficacy and safety profile remain unknown. We performed a systematic review and meta-analysis to determine the safety and efficacy of TC-325 in treating UGIB, based on rates of initial hemostasis, rebleeding, and adverse events (AEs). Methods We searched the MEDLINE/PubMed, EMBASE, CENTRAL, Latin-American and Caribbean Health Sciences Literature databases, as well as the gray literature, to identify articles describing use of TC-325 up to October 2018. Primary outcomes were initial hemostasis and rebleeding. AEs were described as a secondary outcome. Risk of bias was assessed with international scores. Results We identified 2077 records after removal of duplicates. We included 50 studies, involving a collective total of 1445 patients, in the quantitative synthesis. Primary hemostasis and rebleeding rates were 90.7 % and 26.1 %, respectively. Subgroup analyses showed similar results. Only eight AEs were reported. Conclusions TC-325 appears to be a safe, effective treatment for UGIB. The overall rate of initial hemostasis after TC-325 use is high, regardless of etiology of bleeding or whether TC-325 is used as a primary or rescue therapy. Although it is also associated with high rebleeding rates, rates of AEs and equipment failure after TC-325 use are extremely low.

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Efficacy of hemostatic powders in upper gastrointestinal bleeding: A systematic review and meta-analysis

Digestive and Liver Disease ◽

10.1016/j.dld.2019.07.001 ◽

2019 ◽

Vol 51 (12) ◽

pp. 1633-1640 ◽

Cited By ~ 6

Author(s):

Antonio Facciorusso ◽

Marcelo Straus Takahashi ◽

Ceren Eyileten Postula ◽

Vincenzo Rosario Buccino ◽

Nicola Muscatiello

Keyword(s):

Systematic Review ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Meta Analysis ◽

Upper Gastrointestinal

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Su1410 TRANEXAMIC ACID FOR UPPER GASTROINTESTINAL BLEEDING: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Gastroenterology ◽

10.1016/s0016-5085(20)32161-2 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-583

Author(s):

Erica Twum-Barimah ◽

Ibtihal S. Abdelgadir ◽

Morris Gordon ◽

Anthony Akobeng

Keyword(s):

Systematic Review ◽

Gastrointestinal Bleeding ◽

Tranexamic Acid ◽

Randomized Controlled Trials ◽

Upper Gastrointestinal Bleeding ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Upper Gastrointestinal

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Angiotensin II antagonists and gastrointestinal bleeding in left ventricular assist devices: A systematic review and meta-analysis

The International Journal of Artificial Organs ◽

10.1177/0391398820951811 ◽

2020 ◽

pp. 039139882095181

Author(s):

Veraprapas Kittipibul ◽

Wasawat Vutthikraivit ◽

Jakrin Kewcharoen ◽

Pattara Rattanawong ◽

Pakpoom Tantrachoti ◽

...

Keyword(s):

Systematic Review ◽

Angiotensin Ii ◽

Gastrointestinal Bleeding ◽

Angiotensin Receptor Blockers ◽

Meta Analysis ◽

Angiotensin Converting Enzyme Inhibitors ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Converting Enzyme Inhibitors

Gastrointestinal bleeding (GIB) especially from arteriovenous malformations (AVM) remains one of the devastating complications following continuous-flow left ventricular device (CF-LVAD) implantation. Blockade of angiotensin II pathway using angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) was reported to mitigate the risk of GIB and AVM-related GIB by suppressing angiogenesis. We performed a systematic review and meta-analysis to evaluate the association between ACEI/ARB treatment and GIB in CF-LVAD population. Comprehensive literature search was performed through December 2019. We included studies reporting risk of GIB and/or AVM-related GIB events in LVAD patients who received ACEI/ARB with those who did not. Data from each study were combined using the random-effects to calculate odd ratios and 95% confidence intervals. Three retrospective cohort studies were included in this meta-analysis involving 619 LVADs patients (467 patients receiving ACEI/ARB). The use of ACEI/ARB was statistically associated with decreased incidence of overall GIB (pooled OR 0.35, 95% CI 0.22–0.56, I2 = 0.0%, p < 0.001). There was a non-significant trend toward lower risk for AVM-related GIB in patients who received ACEI/ARB (pooled OR 0.46, 95% CI 0.19–1.07, I2 = 51%, p = 0.07). Larger studies with specific definitions of ACEI/ARB use and GIB are warranted to accurately determine the potential non-hemodynamic benefits of ACEI/ARB in CF-LVAD patients.

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Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline

BMJ ◽

10.1136/bmj.l6722 ◽

2020 ◽

pp. l6722 ◽

Cited By ~ 4

Author(s):

Zhikang Ye ◽

Annika Reintam Blaser ◽

Lyubov Lytvyn ◽

Ying Wang ◽

Gordon H Guyatt ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Gastrointestinal Bleeding ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Risk Of Bleeding ◽

Weak Recommendation ◽

Guideline Panel ◽

Bleeding Prophylaxis

AbstractClinical questionWhat is the role of gastrointestinal bleeding prophylaxis (stress ulcer prophylaxis) in critically ill patients? This guideline was prompted by the publication of a new large randomised controlled trial.Current practiceGastric acid suppression with proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) is commonly done to prevent gastrointestinal bleeding in critically ill patients. Existing guidelines vary in their recommendations of which population to treat and which agent to use.RecommendationsThis guideline panel makes a weak recommendation for using gastrointestinal bleeding prophylaxis in critically ill patients at high risk (>4%) of clinically important gastrointestinal bleeding, and a weak recommendation for not using prophylaxis in patients at lower risk of clinically important bleeding (≤4%). The panel identified risk categories based on evidence, with variable certainty regarding risk factors. The panel suggests using a PPI rather than a H2RA (weak recommendation) and recommends against using sucralfate (strong recommendation).How this guideline was createdA guideline panel including patients, clinicians, and methodologists produced these recommendations using standards for trustworthy guidelines and the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. A weak recommendation means that both options are reasonable.The evidenceThe linked systematic review and network meta-analysis estimated the benefit and harm of these medications in 12 660 critically ill patients in 72 trials. Both PPIs and H2RAs reduce the risk of clinically important bleeding. The effect is larger in patients at higher bleeding risk (those with a coagulopathy, chronic liver disease, or receiving mechanical ventilation but not enteral nutrition or two or more of mechanical ventilation with enteral nutrition, acute kidney injury, sepsis, and shock) (moderate certainty). PPIs and H2RAs might increase the risk of pneumonia (low certainty). They probably do not have an effect on mortality (moderate certainty), length of hospital stay, or any other important outcomes. PPIs probably reduce the risk of bleeding more than H2RAs (moderate certainty).Understanding the recommendationIn most critically ill patients, the reduction in clinically important gastrointestinal bleeding from gastric acid suppressants is closely balanced with the possibility of pneumonia. Clinicians should consider individual patient values, risk of bleeding, and other factors such as medication availability when deciding whether to use gastrointestinal bleeding prophylaxis. Visual overviews provide the relative and absolute benefits and harms of the options in multilayered evidence summaries and decision aids available on MAGICapp.

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