Safety and Efficacy of the Non-Cessation Method of Antithrombotic Agents After Emergency Endoscopic Hemostasis in Patients with Non-Variceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study

Abstract Background and Aims The present study aimed to clarify the safety and efficacy of the non-cessation method of antithrombotic agents after emergency endoscopic hemostasis in Japanese patients with non-variceal upper gastrointestinal bleeding (UGIB). Methods In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for non-variceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcome and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis. Results Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than group B (97.5% vs. 60.0%, P < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than group B (8.6 ± 5.2 d vs. 14.4 ± 7.1 d, P < 0.001). Conclusions Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for non-variceal UGIB.

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Safety and Efficacy of the Noncessation Method of Antithrombotic Agents after Emergency Endoscopic Hemostasis in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/6672440 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Daisuke Yamaguchi ◽

Naoyuki Tominaga ◽

Koichi Miyahara ◽

Nanae Tsuruoka ◽

Yasuhisa Sakata ◽

...

Keyword(s):

Pilot Study ◽

Propensity Score ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Antithrombotic Agents ◽

Safety And Efficacy ◽

Group A ◽

Group B ◽

Upper Gastrointestinal

Background and Aims. The present study aimed to clarify the safety and efficacy of the noncessation method of antithrombotic agents after emergency endoscopic hemostasis in patients with nonvariceal upper gastrointestinal bleeding (UGIB). Methods. In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for nonvariceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcomes and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis. Results. Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than in group B (97.5% versus 60.0%, P < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than in group B (8.6 ± 5.2 d versus 14.4 ± 7.1 d, P < 0.001). Conclusions. Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for nonvariceal UGIB.

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Efficacy of a novel hemostatic adhesive powder in patients with refractory upper gastrointestinal bleeding: a pilot study

Endoscopy ◽

10.1055/a-0809-5276 ◽

2019 ◽

Vol 51 (05) ◽

pp. 458-462 ◽

Cited By ~ 1

Author(s):

Jin-Seok Park ◽

Byung Wook Bang ◽

Su Jin Hong ◽

Eunhye Lee ◽

Kye Sook Kwon ◽

...

Keyword(s):

Pilot Study ◽

Gastrointestinal Bleeding ◽

Success Rate ◽

Salvage Therapy ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

High Success Rate ◽

Bleeding Site ◽

Endoscopic Procedures ◽

Upper Gastrointestinal

Abstract Background A new hemostatic adhesive powder (UI-EWD) has been developed to reduce the high re-bleeding rates associated with the currently available hemostatic powders. The current study aimed to assess the efficacy of UI-EWD as a salvage therapy for the treatment of refractory upper gastrointestinal bleeding (UGIB). Methods A total of 17 consecutive patients who had failed to achieve hemostasis with conventional endoscopic procedures and had undergone treatment with UI-EWD for endoscopic hemostasis in refractory UGIB were prospectively enrolled in the study. We evaluated the success rate of initial hemostasis and rate of re-bleeding within 30 days. Results All patients underwent successful UI-EWD application at the bleeding site. Initial hemostasis occurred in 16/17 patients (94 %). Re-bleeding within 30 days occurred in 3/16 patients (19 %) who had achieved initial hemostasis. In the second-look endoscopy after 24 hours, hydrogel from UI-EWD was found attached at the bleeding site in 11/16 patients (69 %). Conclusion UI-EWD has a high success rate for initial hemostasis in refractory UGIB and shows promising results in the prevention of re-bleeding.

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Vascular Parenchymal Sources of Upper Gastrointestinal Bleeding

Acta Radiologica ◽

10.1177/028418518903000109 ◽

1989 ◽

Vol 30 (1) ◽

pp. 39-43 ◽

Cited By ~ 8

Author(s):

S. Savastano ◽

G. P. Feltrin ◽

D. Miotto ◽

M. Chiesura-Corona ◽

L. Rubaltelli ◽

...

Keyword(s):

Computed Tomography ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Emergency Endoscopy ◽

Severe Hemorrhage ◽

Group A ◽

Group B ◽

Upper Gastrointestinal ◽

Selection Of Patients ◽

Selection Of

Fourteen cases of upper gastrointestinal bleeding (UGIB) were reviewed: 6 (group A) were caused by pancreatitis, 3 (group B) by hemobilia, and 5 (group C) by rupture of esophageal varices due to arterioportal shunts. Elective endoscopy carried out in 7 patients in groups A and B was negative; in 2 actively bleeding patients in group A emergency endoscopy could not detect the source of hemorrhage. Endoscopy was carried out in 4 patients in group C for diagnosis and sclerosis, but severe hemorrhage recurred in spite of treatment. Ultrasonography (US) and computed tomography (CT) were carried out prior to angiography in 5 and 4 patients, respectively, and always suggested a parenchymal lesion. All patients underwent angiography. Transcatheter control of the hemorrhage was attempted as an emergency in 2 patients (as a presurgical step in one); elective embolization was the treatment of choice for 8 patients, with good results in 6. This study suggests the usefulness of US and CT both in the detection of parenchymal lesions causing UGIB not clarified by endoscopy, and in the selection of patients for angiographic treatment.

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Endoscopic reinforcement of the anastomosis followed by targeted endoscopic hemostasis for massive upper gastrointestinal bleeding after Whipple’s surgery

Endoscopy ◽

10.1055/s-0041-110592 ◽

2016 ◽

Vol 48 (S 01) ◽

pp. E22-E23

Author(s):

Marco D’Assunçao ◽

Paul Kröner ◽

Ujjwal Kumar ◽

Juan Gutierrez ◽

Lucia Fry ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Upper Gastrointestinal

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A pilot study comparing two physiotherapy techniques in patietnts with cystic fibrosis

South African Journal of Physiotherapy ◽

10.4102/sajp.v60i2.183 ◽

2004 ◽

Vol 60 (2) ◽

Cited By ~ 7

Author(s):

S. M. Milne ◽

C. J. Eales

Keyword(s):

Cystic Fibrosis ◽

Pilot Study ◽

Lung Function ◽

Statistical Difference ◽

Positive Pressure ◽

Lung Function Tests ◽

Bronchial Secretions ◽

Group A ◽

Group B ◽

Minimal Research

The flutter is a simple hand held device designed to facilitate the mobilisation of excess bronchial secretions by means of oscillating positive pressure. Traditionally patients at the Johannesburg Hospital Cystic Fibrosis clinic used the active cycle of breathing technique as a means of facilitating secretion mobilisation and clearance. When the flutter became available in South Africa in 1999 many cystic fibrosis patients wanted to change to this technique. Minimal research has been conducted comparing these two techniques. The aim of this pilot study was therefore to determine which technique is more effective in the mobilisation of secretions in cystic fibrosis patients. The pilot study was conducted on seven cystic fibrosis patients (mean age 28 years, range 16-42 years) admitted to the Johannesburg Hospital for antibiotic therapy. The study lasted four days and consisted of two treatment days separated by a washout day on which no physiotherapy was performed. Patients randomised into Group A performed the flutter technique on day two and the active cycle of breathing technique on day four. Group B performed the active cycle of breathing technique on day two and the flutter on day four. The techniques were performed twice a day for 15 minutes. The measurements taken were daily 24-hour sputum samples and daily lung function tests. A questionnaire to determine patient preference to a technique concluded the study. The results showed no statistical difference between the two techniques with regard to sputum weight or lung function (p<0.05). The questionnaire indicated that on a whole, patients had no preference for a technique.

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CLINICAL EVALUATION OF EMERGENCY ENDOSCOPIC HEMOSTASIS WITH BIPOLAR FORCEPS IN NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

Digestive Endoscopy ◽

10.1111/j.1443-1661.2010.00949.x ◽

2010 ◽

Vol 22 (2) ◽

pp. 151-155 ◽

Cited By ~ 14

Author(s):

Mikinori Kataoka ◽

Takashi Kawai ◽

Kenji Yagi ◽

Chizuko Tachibana ◽

Hiroyuki Tachibana ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Clinical Evaluation ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Upper Gastrointestinal

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Dose-intensive cyclophosphamide with etoposide and vincristine for pediatric solid tumors: a phase I/II pilot study by the Australia and New Zealand Childhood Cancer Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.3.522 ◽

1994 ◽

Vol 12 (3) ◽

pp. 522-531 ◽

Cited By ~ 18

Author(s):

L White ◽

G McCowage ◽

G Kannourakis ◽

V Nayanar ◽

L Colnan ◽

...

Keyword(s):

New Zealand ◽

Pilot Study ◽

Childhood Cancer ◽

Solid Tumors ◽

Hematologic Toxicity ◽

Study Group ◽

Cancer Study ◽

Cancer Study Group ◽

Group A ◽

Group B

PURPOSE This pilot study of the Australia and New Zealand Childhood Cancer Study Group investigated the effectiveness and toxicity of a regimen incorporating vincristine (VCR), etoposide, and divided-dose, escalating cyclophosphamide (CPA) (VETOPEC) in 23 patients aged 1 to 20 years with solid tumors. PATIENTS AND METHODS Seventeen patients (group A) had recurrent or refractory tumors after prior multiagent therapy, and six patients (group B) with adverse prognostic indicators were treated at initial presentation. Treatment cycles were 21 to 28 days and consisted of vincristine (0.05 mg/kg) on days 1 and 14, with etoposide (2.5 mg/kg/d) plus escalating CPA on days 1, 2, and 3. The CPA dosage was escalated from 30 mg/kg/d in cycle no. 1 by 5 mg/kg/d in each cycle to a maximum of 55 mg/kg/d in cycle no. 6. RESULTS Of 20 patients assessable for tumor response, 19 (95%) responded after two to six cycles of VETOPEC: seven complete responses (CRs); eight very good partial responses (VGPRs); and four partial responses (PRs). In group A, 13 of 14 (93%) assessable patients responded (five CRs, four VGPRs, four PRs), and in group B, five stage IV and one stage III patient achieved two CRs and four VGPRs. The principal toxicity was myelosuppression. Grade IV neutropenia occurred after 98% of cycles, and the incidence of grade IV thrombocytopenia increased from 37% after cycle no. 1 to 91% after cycle no. 6 (P = .002). A total of 115 cycles delivered were followed by 62 febrile admissions (54%), and showed a significant rise with increasing cycles (P = .001). One patient died of septicemia. CONCLUSION This combination and scheduling produced a high response rate in patients with recurrent, refractory, or advanced solid tumors of childhood. Further studies of this regimen and of strategies to reduce hematologic toxicity are warranted.

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Assessment of Degree of Health of the Stomach by Concomitant Measurement of Serum Pepsinogen and Serum Helicobacter Pylori Antibodies

The International Journal of Biological Markers ◽

10.5301/jbm.2010.6087 ◽

2010 ◽

Vol 25 (4) ◽

pp. 207-212 ◽

Cited By ~ 22

Author(s):

Kazuhiko Inoue ◽

Tomoo Fujisawa ◽

Ken Haruma

Keyword(s):

Helicobacter Pylori ◽

Gastrointestinal Endoscopy ◽

Upper Gastrointestinal Endoscopy ◽

Gastric Adenoma ◽

Fundic Gland ◽

Peptic Ulcers ◽

Serum Pepsinogen ◽

Group A ◽

Group B ◽

Upper Gastrointestinal

The stomach was assessed by measuring serum pepsinogen (PG) and Helicobacter pylori (Hp) antibodies by immunoassay, based on the findings of upper gastrointestinal endoscopy performed on the same day. The assessment involved 1,636 individuals who visited the hospital for general medical checkups. Those negative for Hp antibodies and PG were grouped in group A, Hp-positive/PG-negative subjects were included in group B, and PG-positive subjects in group C. Group A comprised 660 subjects (40.3%), group B 514 (31.4%), and group C 462 (28.2%). Gastric cancer was detected in 0.87% (4/462) in group C, 0.19% (1/514) in group B, and 0% (0/660) in group A. All four patients with gastric adenoma were in group C. Hyperplastic polyps were detected most frequently in group C followed by group B, while there were no cases in group A. By contrast, most fundic gland polyps were found in group A. The detection rate of peptic ulcers was highest in group B, while that of reflux esophagitis was highest in group A. These findings suggest that the “degree of health” of the stomach can be assessed by measuring serum PG and Hp antibodies.

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P3123Enoxaparin versus unfractionated heparin in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

European Heart Journal ◽

10.1093/eurheartj/ehz745.0198 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Graca Santos ◽

R Ribeiro Carvalho ◽

F Montenegro ◽

C Ruivo ◽

J Correia ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Propensity Score ◽

Major Bleeding ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

Group A ◽

St Elevation ◽

Group B

Abstract Background The use of intravenous enoxaparin (LBWH) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) was upgraded in the latest European Guidelines to a class IIa recommendation. Purpose The authors aim to compare safety and prognostic impact of LMWH versus unfractionated heparin (UFH) use in STEMI patients undergoing primary PCI. Methods Retrospective study of 3875 STEMI patients who underwent pPCI between October 2010 and September 2017 and were included in a national multicenter registry. Group A consisted of patients managed only with LMWH, and Group B patients were treated with UFH regardless of eventual LMWH associated exposure. The groups were compared according to their demographic, clinical and laboratory characteristics. The primary endpoint (PE) results from a composite which included: procedural failure (pPCI failure or bailout use of GPIIb/IIIa inhibitors), in-hospital mortality, re-infarction or major bleeding (according to the registry criteria). The secondary endpoint (SE) included: in-hospital major bleeding, need for red blood cell transfusion, or haemoglobin drop ≥2g/dL. A 1:1 propensity score (PS) analysis was performed according to demographic variables, medical history and previous medication, physical examination, electrocardiogram characteristics and left ventricular function, matching 1558 of the 3875 patients for later comparison between groups. Results Overall, Group A included 1083 (27.9%) and Group B 2792 (72.1%) patients. The mean age was 63±14 years, and 33.5% of the cohort were female. Despite the baseline characteristics heterogeneity between groups, this phenomenon was not observed after PS matching. The PE was more frequent in Group A, without reaching statistical relevance (15.6% vs 13.3%, p=0.07). The SE was superior in Group A (34.4 vs 29.4%, p=0.01). According to the PS matching analysis, there were no differences beetween groups in terms of the PE (13.9% vs 12.0%, p=0.28), while the SE kept more frequent among Group A (34.9% vs 28.5%, p=0.02) [Figure]. Propensity score: group comparison Conclusion In this study based on a national multicentric registry of STEMI patients, the use of LMWH was not associated with better in-hospital prognosis in terms of major cardiovascular events and was related with higher rates of bleeding related events in the scenario of pPCI, compared to UFH. According to these results, further studies are required to support the widespread use of LMWH in this clinical scenario.

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