scholarly journals Blood transfusion strategy in cirrhotic patients with active upper GI bleeding

2019 ◽  
Vol 4 ◽  
pp. 1-1 ◽  
Author(s):  
Vishnu Prasad Nelamangala-Ramakrishnaiah ◽  
Vijayakumar Chellappa ◽  
Mangala Goneppanavar
Keyword(s):  
Blood Transfusion ◽  
Gi Bleeding ◽  
Transfusion Strategy ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Cirrhotic Patients

scholarly journals CIRRHOTIC PATIENTS;

2013 ◽  
Vol 20 (06) ◽  
pp. 876-881
Author(s):  
MUHAMMAD ADNAN BAWANY ◽  
JAHANGIR LIAQUAT ◽  
MUHMMAD AKBER ◽  
Falak Naz ◽  
Shereen Rahat Khanzada ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Esophageal Varices ◽  
University Hospital ◽  
Oesophageal Varices ◽  
Gi Bleeding ◽  
Upper Gi Bleeding ◽  
Hospital Design ◽  
Upper Gi ◽  
Predicting Factors ◽  
Cirrhotic Patients

Objective: To determine the frequency of upper GI bleeding and its predicting factors and esophageal varices in the patientswith liver cirrhosis disease admitted at medicine ward of Isra university hospital. Design: Prospective and observational study. Setting:Isra university hospital. Period: March 2012 to August 2012 (six months). Methods: Containing 100 patients, mean age was 45.8, and allthe patients with cirrhosis disease were included in this study with liver cirrhosis disease. All patients were under went endoscopy andFrequency of upper GI bleeding and varices presentation and classification according to grade were noted. Results: All the 100 patientswere selected on the basis of presenting liver cirrhosis disease. Male were more found than the female with the mean age 45.8. Mostlycirrhotic patients were found with HCV positive and upper GI bleeding were noted in (40%) of the cases. With the endoscopic findingmostly patients were noted in ll - lll grad of esophageal varices and according to child pug classification majority of patients was noted inclass “C” In addition, thrombocytopenia and red wale markings along with the presence of large sized varices were associated with thepresence of esophageal varices. Conclusions: In the conclusion of this study we found majority of the cirrhotic patients with HCV,Esophageal varices and thrombocytopenia are the important factors of upper GI bleeding. Knowledge and etiology of this manuscript mayhelpful in the prevention of oesophageal varices and upper GI bleeding.

scholarly journals Tranexamic acid for acute gastrointestinal bleeding (The HALT-IT trial): Statistical analysis plan for an international, randomised, double blind, placebo-controlled trial

2019 ◽  
Author(s):  
Amy Charlotte Brenner ◽  
Adefemi Afolabi ◽  
Syed Masroor Ahmad ◽  
Monica Arribas ◽  
Rizwana Chaudhri ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Gi Bleeding ◽  
Double Blind ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Lower Gi Bleeding

Abstract Background: Acute gastrointestinal (GI) bleeding is an important cause of mortality worldwide. Bleeding can occur from the upper or lower GI tract, with upper GI bleeding accounting for most cases. The main causes include peptic ulcer / erosive mucosal disease, oesophageal varices and malignancy. The case fatality rate is around 10% for upper GI bleeding and 3% for lower GI bleeding. Rebleeding affects 5-40% of patients and is associated with a four-fold increased risk of death. Tranexamic acid (TXA) decreases bleeding and the need for blood transfusion in surgery and reduces death due to bleeding in patients with trauma and postpartum haemorrhage. It reduces bleeding by inhibiting the breakdown of fibrin clots by plasmin. Due to the methodological weaknesses and small size of the existing trials, the effectiveness and safety of TXA in GI bleeding is uncertain. The HALT-IT trial aims to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding. Methods: The HALT-IT trial is an international, randomised, double blind (participant and trial staff), placebo-controlled trial of tranexamic acid in 12,000 adults (increased from 8,000) with acute upper or lower GI bleeding. Eligible patients are randomly allocated to receive tranexamic acid (1g loading dose followed by 3g maintenance dose over 24 hours) or matching placebo. The main analysis will compare those randomised to tranexamic acid with those randomised to placebo on an intention-to-treat basis, presenting the results as effect estimates (relative risks) and confidence intervals. The primary outcome is death due to bleeding within 5 days of randomisation and secondary outcomes are rebleeding, all-cause and cause-specific mortality, thromboembolic events, complications, endoscopic, radiological and surgical interventions, blood transfusion requirements, disability (defined by a measure of patient’s self-care capacity) and number of days spent in intensive care or high dependency units. Subgroup analyses for the primary outcome will consider time to treatment, location of bleeding, cause of bleed and clinical Rockall score. Discussion: We present the statistical analysis of the HALT-IT trial. This plan was published before the treatment allocation was un-blinded.

scholarly journals Tranexamic acid for acute gastrointestinal bleeding (The HALT-IT trial): Statistical analysis plan for an international, randomised, double blind, placebo-controlled trial

2019 ◽  
Author(s):  
Amy Charlotte Brenner ◽  
Adefemi Afolabi ◽  
Syed Masroor Ahmad ◽  
Monica Arribas ◽  
Rizwana Chaudhri ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Gi Bleeding ◽  
Double Blind ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Lower Gi Bleeding

Abstract Background: Acute gastrointestinal (GI) bleeding is an important cause of mortality worldwide. Bleeding can occur from the upper or lower GI tract, with upper GI bleeding accounting for most cases. The main causes include peptic ulcer / erosive mucosal disease, oesophageal varices and malignancy. The case fatality rate is around 10% for upper GI bleeding and 3% for lower GI bleeding. Rebleeding affects 5-40% of patients and is associated with a four-fold increased risk of death. Tranexamic acid (TXA) decreases bleeding and the need for blood transfusion in surgery and reduces death due to bleeding in patients with trauma and postpartum haemorrhage. It reduces bleeding by inhibiting the breakdown of fibrin clots by plasmin. Due to the methodological weaknesses and small size of the existing trials, the effectiveness and safety of TXA in GI bleeding is uncertain. The HALT-IT trial aims to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding. Methods: The HALT-IT trial is an international, randomised, double blind (participant and trial staff), placebo-controlled trial of tranexamic acid in 12,000 adults (increased from 8,000) with acute upper or lower GI bleeding. Eligible patients are randomly allocated to receive tranexamic acid (1g loading dose followed by 3g maintenance dose over 24 hours) or matching placebo. The main analysis will compare those randomised to tranexamic acid with those randomised to placebo on an intention-to-treat basis, presenting the results as effect estimates (relative and absolute risks) and confidence intervals. The primary outcome is death due to bleeding within 5 days of randomisation and secondary outcomes are rebleeding, all-cause and cause-specific mortality, thromboembolic events, complications, endoscopic, radiological and surgical interventions, blood transfusion requirements, disability (defined by a measure of patient’s self-care capacity) and number of days spent in intensive care or high dependency units. Subgroup analyses for the primary outcome will consider time to treatment, location of bleeding, cause of bleed and clinical Rockall score. Discussion: We present the statistical analysis of the HALT-IT trial. This plan was published before the treatment allocation was un-blinded.

scholarly journals Tranexamic acid for acute gastrointestinal bleeding (The HALT-IT trial): Statistical analysis plan for an international, randomised, double blind, placebo-controlled trial

2019 ◽  
Author(s):  
Amy Charlotte Brenner ◽  
Adefemi Afolabi ◽  
Syed Masroor Ahmad ◽  
Monica Arribas ◽  
Rizwana Chaudhri ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Blood Transfusion ◽  
Tranexamic Acid ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Gi Bleeding ◽  
Double Blind ◽  
Upper Gi Bleeding ◽  
Upper Gi ◽  
Lower Gi Bleeding

Abstract Background: Acute gastrointestinal (GI) bleeding is an important cause of mortality worldwide. Bleeding can occur from the upper or lower GI tract, with upper GI bleeding accounting for most cases. The main causes include peptic ulcer / erosive mucosal disease, oesophageal varices and malignancy. The case fatality rate is around 10% for upper GI bleeding and 3% for lower GI bleeding. Rebleeding affects 5-40% of patients and is associated with a four-fold increased risk of death. Tranexamic acid (TXA) decreases bleeding and the need for blood transfusion in surgery and reduces death due to bleeding in patients with trauma and postpartum haemorrhage. It reduces bleeding by inhibiting the breakdown of fibrin clots by plasmin. Due to the methodological weaknesses and small size of the existing trials, the effectiveness and safety of TXA in GI bleeding is uncertain. The HALT-IT trial aims to provide reliable evidence about the effects of TXA in acute upper and lower GI bleeding. Methods: The HALT-IT trial is an international, randomised, double blind (participant and trial staff), placebo-controlled trial of tranexamic acid in 12,000 adults (increased from 8,000) with acute upper or lower GI bleeding. Eligible patients are randomly allocated to receive tranexamic acid (1g loading dose followed by 3g maintenance dose over 24 hours) or matching placebo. The main analysis will compare those randomised to tranexamic acid with those randomised to placebo on an intention-to-treat basis, presenting the results as effect estimates (relative and absolute risks) and confidence intervals. The primary outcome is death due to bleeding within 5 days of randomisation and secondary outcomes are rebleeding, all-cause and cause-specific mortality, thromboembolic events, complications, endoscopic, radiological and surgical interventions, blood transfusion requirements, disability (defined by a measure of patient’s self-care capacity) and number of days spent in intensive care or high dependency units. Subgroup analyses for the primary outcome will consider time to treatment, location of bleeding, cause of bleed and clinical Rockall score. Discussion: We present the statistical analysis of the HALT-IT trial. This plan was published before the treatment allocation was un-blinded.

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