Association between TNF‐α polymorphisms and the risk of upper gastrointestinal bleeding induced by aspirin in patients with coronary heart disease

2018 ◽  
Vol 83 (3) ◽  
pp. 124-133 ◽  
Author(s):  
Tai‐ping Wang
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Tnf Α ◽  
Upper Gastrointestinal

scholarly journals Risk Factors for Acute Coronary Syndrome in Upper Gastrointestinal Bleeding Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Tianyu Chi ◽  
Quchuan Zhao ◽  
Peili Wang
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Heart Disease ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Coronary Syndrome ◽  
Upper Gastrointestinal

Background. Upper gastrointestinal bleeding (UGIB) is a common critical disease with a certain fatality rate. Acute coronary syndrome (ACS), another critical ill condition, is a regular occurrence in the UGIB. We identified risk factors for ACS in UGIB. Methods. 676 patients diagnosed with UGIB were enrolled retrospectively. We assessed the occurrence of ACS in UGIB patients and identified the risk factors for ACS by logistic regression analysis and random forest analysis. Results. After propensity score matching (PSM), the ACS group ( n = 69 ) and non-ACS group ( n = 276 ) were analyzed. Logistic regression analysis showed that syncope ( P = 0.001 ), coronary heart disease history ( P = 0.001 ), Glasgow Blatchford score ( P ≤ 0.001 ), Rockall risk score ( P = 0.004 ), red blood cell distribution width (RDW) ( P ≤ 0.001 ), total bilirubin (TBil) ( P = 0.046 ), fibrinogen ( P ≤ 0.001 ), and hemoglobin ( P = 0.001 ) had important roles in ACS patients. With Mean Decrease Gini (MDG) sequencing, fibrinogen, RDW, and hemoglobin were ranked the top three risk factors associated with ACS. In ROC analysis, fibrinogen ( AUC = 0.841 , 95% CI: 0.779-0.903) and RDW ( AUC = 0.826 , 95% CI: 0.769-0.883) obtained good discrimination performance. According to sensitivity > 80 %, the pAUC of fibrinogen and RDW were 0.077 and 0.101, respectively, and there was no significant difference ( P = 0.326 ). However, according to specificity > 80 %, the pAUC of fibrinogen was higher than that of RDW (0.126 vs. 0.088, P = 0.018 ). Conclusion. Fibrinogen and RDW were important risk factors for ACS in UGIB. Additionally, combination with coronary heart disease, syncope, hemoglobin, and TBil played important roles in the occurrence of ACS. Meanwhile, it was also noted that Rockall score and Glasgow Blatchford score should be performed to predict the risk.

scholarly journals Stress Ulcer Prophylaxis versus Placebo - a Blinded Randomized Control Trial to Evaluate the Safety of Two Strategies in Critically Ill Infants with Congenital Heart Disease (SUPPRESS-CHD)

2020 ◽  
Author(s):  
Kimberly I. Mills ◽  
Ben D. Albert ◽  
Lori J. Bechard ◽  
Christopher P. Duggan ◽  
Aditya Kaza ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Congenital Heart ◽  
Upper Gastrointestinal Bleeding ◽  
Safety And Efficacy ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
Upper Gastrointestinal

Abstract Background: Critically ill infants with congenital heart disease (CHD) are often prescribed stress ulcer prophylaxis (SUP) to prevent upper gastrointestinal bleeding, despite the low incidence of stress ulcers and limited data on the safety and efficacy of SUP in infants. Recently, SUP has been associated with an increased incidence of hospital-acquired infections, community-acquired pneumonia and necrotizing enterocolitis. The objective of this pilot study is to investigate the feasibility of performing a randomized controlled trial to assess the safety and efficacy of withholding SUP in infants with congenital heart disease admitted to the cardiac intensive care unit. Methods: A single center, prospective, double-blinded, randomized placebo-controlled pilot feasibility trial will be performed in infants with CHD admitted to the cardiac intensive care unit and anticipated to require respiratory support for > 24 hours. Patients will be randomized to receive a histamine-2 receptor antagonist (H2RA) or placebo until they are discontinued from respiratory support. Randomization will be performed within 2 strata defined by admission type (medical or surgical) and age (neonate, age <30 days, or infant, 1 month to 1 year). Allocation will be a 1:1 ratio using permuted blocks to ensure balanced allocations across the two treatment groups within each stratum. The primary outcomes include feasibility of screening, consent, timely allocation of study drug, and protocol adherence. The primary safety outcome is the rate of clinically significant upper gastrointestinal bleeding. The secondary outcomes are the difference in the relative and absolute abundance of the gut microbiota and functional microbial profiles between the two study groups. We plan to enroll 100 patients in this pilot study. Discussion: Routine use of SUP to prevent upper gastrointestinal bleeding in infants is controversial due to a low incidence of bleeding events and concern for adverse effects. The role of SUP in infants with CHD has not been examined and there is equipoise on the risks and benefits of withholding this therapy. In addition, this therapy has been discontinued in other neonatal populations due to the concern for hospital-acquired infections and necrotizing enterocolitis. Furthermore, exploring changes to the microbiome after exposure to SUP may highlight the mechanisms by which SUP impacts potential microbial dysbiosis of the gut and its association with hospital-acquired infections. Assessment of the feasibility of a trial of witholding SUP in critically ill infants with CHD will facilitate planning of a larger multicenter trial of safety and efficacy of SUP in this vulnerable population. Trial registration: NCT03667703; submitted September 12, 2018

scholarly journals Stress Ulcer Prophylaxis versus Placebo - a Blinded Randomized Control Trial toEvaluate the Safety of Two Strategies in Critically Ill Infants with Congenital Heart Disease (SUPPRESS-CHD)

2020 ◽  
Author(s):  
Kimberly I. Mills ◽  
Ben D. Albert ◽  
Lori J. Bechard ◽  
Christopher P. Duggan ◽  
Aditya Kaza ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Congenital Heart ◽  
Upper Gastrointestinal Bleeding ◽  
Safety And Efficacy ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
Upper Gastrointestinal

Abstract Background: Critically ill infants with congenital heart disease (CHD) are often prescribed stress ulcer prophylaxis (SUP) to prevent upper gastrointestinal bleeding, despite the low incidence of stress ulcers and limited data on the safety and efficacy of SUP in infants. Recently, SUP has been associated with an increased incidence of hospital-acquired infections, community-acquired pneumonia and necrotizing enterocolitis. The objective of this pilot study is to investigate the feasibility of performing a randomized controlled trial to assess the safety and efficacy of withholding SUP in infants with congenital heart disease admitted to the cardiac intensive care unit. Methods: A single center, prospective, double-blinded, randomized placebo-controlled pilot feasibility trial will be performed in infants with CHD admitted to the cardiac intensive care unit and anticipated to require respiratory support for > 24 hours. Patients will be randomized to receive a histamine-2 receptor antagonist (H2RA) or placebo until they are discontinued from respiratory support. Randomization will be performed within 2 strata defined by admission type (medical or surgical) and age (neonate, age <30 days, or infant, 1 month to 1 year). Allocation will be a 1:1 ratio using permuted blocks to ensure balanced allocations across the two treatment groups within each stratum. The primary outcomes include feasibility of screening, consent, timely allocation of study drug, and protocol adherence. The primary safety outcome is the rate of clinically significant upper gastrointestinal bleeding. The secondary outcomes are the difference in the relative and absolute abundance of the gut microbiota and functional microbial profiles between the two study groups. We plan to enroll 100 patients in this pilot study. Discussion: Routine use of SUP to prevent upper gastrointestinal bleeding in infants is controversial due to a low incidence of bleeding events and concern for adverse effects. The role of SUP in infants with CHD has not been examined and there is equipoise on the risks and benefits of withholding this therapy. In addition, this therapy has been discontinued in other neonatal populations due to the concern for hospital-acquired infections and necrotizing enterocolitis. Furthermore, exploring changes to the microbiome after exposure to SUP may highlight the mechanisms by which SUP impacts potential microbial dysbiosis of the gut and its association with hospital-acquired infections. Assessment of the feasibility of a trial of witholding SUP in critically ill infants with CHD will facilitate planning of a larger multicenter trial of safety and efficacy of SUP in this vulnerable population.Trial registration: Clinicaltrials.gov; NCT03667703; submitted September 12, 2018

scholarly journals Use of the over-the-scope-clip (OTSC) in non-variceal upper gastrointestinal bleeding in patients with severe cardiovascular comorbidities: a retrospective study

2017 ◽  
Vol 05 (09) ◽  
pp. E875-E882 ◽  
Author(s):  
Edris Wedi ◽  
Daniel von Renteln ◽  
Susana Gonzalez ◽  
Olena Tkachenko ◽  
Carlo Jung ◽  
...  
Keyword(s):  
Heart Disease ◽  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Anticoagulation Therapy ◽  
Second Line ◽  
Cardiovascular Comorbidities ◽  
Co Morbidity ◽  
Over The Scope Clip ◽  
Upper Gastrointestinal

Abstract Introduction The over-the-scope-clip (OTSC) can potentially overcome limitations of standard clips and achieve more efficient and reliable hemostasis. Data on OTSC use for non-variceal upper gastrointestinal bleeding (NVUGIB) in patients with cardiovascular comorbidities are currently limited. Patients and methods We prospectively collected and retrospectively analyzed our database from February 2009 to September 2015 from all patients who underwent emergency endoscopy for high-risk NVUGIB in 2 academic centers and were treated with OTSC as first-line (n = 81) or second-line therapy (n = 19). Results One hundred patients mean age 72 (range 27 – 97 years) were included in this study. Fifty-one percent (n = 51) had severe cardiovascular co-morbidity (ischemic heart disease, congestive heart failure, hypertension, valvular heart disease, peripheral arterial occlusive disease and atrial fibrillation) and 73 % (n = 73) were on antiplatelet or/and anticoagulation therapy. The median size of the treated ulcers was 3 cm (range 1 – 5 cm). In 94 % (n = 94) primary hemostasis with OTSC was achieved. Clinical long-term success during a mean 6-month follow-up without rebleeding was 86 % (n = 86). Conclusions In this cohort OTSC was demonstrated to be a safe and effective first- or second-line treatment for NVUGIB in high-risk patients with cardiovascular disease and complex, large ulcers. Meeting presentations: Annual Meeting of the German Society of Endoscopy (DEGBV) in Mannheim, Germany, March 17th–19th, 2016 and DDW 2016 in San Diego, United States

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