S655 Risk of GI Bleeding After Urgent ERCP in Patients on Dual Anti-Platelet Therapy: A Nationwide Population-Based Cohort Study
Pourquoi ce travail est dans la base
Une base qui oublie comment elle a trouvé un travail ne peut pas être vérifiée. Voici les voies qui ont admis celui-ci.
Notice bibliographique
Résumé
Introduction: Discontinuation of dual anti-platelet therapy (DaPT) is not always feasible prior to urgent high-risk endoscopic procedures. The primary aim of our study was to assess the risk and severity of clinically significant GI bleeding and its outcomes after urgent ERCP in patients on DaPT. Methods: We performed a retrospective analysis in the IBM Explorys database (1999-2021), a pooled, national, de-identified clinical database of over 74 million unique patients from 300 hospitals across the United States. Patient populations were identified using SNOMED and ICD codes. The DaPT cohort included patients with myocardial infarction or endovascular stent placement who were on aspirin and clopidogrel; and subsequently developed cholangitis or biliary obstruction within 1 year and had ERCP within 3 days. Clinically significant GI bleeding was defined as needing esophagogastroduodenoscopy (EGD) within 7 days of ERCP. Control cohort did not include patients on aspirin or other anti-platelet agents. We excluded patients with any other etiology of GI bleeding from both cohorts. Clinical outcomes assessed included early GI bleeding (< 2 days), late GI bleeding (2-7 days), cardiac arrest within 30 days, embolization, blood transfusion and repeat EGD. Odds ratios with 95% confidence intervals (CI) was performed to compare the risk of each clinical outcome between the cohorts. Results: Patients in DaPT cohort had a higher risk of cardiac arrest (OR 7.74, 95% CI 5.19 - 11.55) and blood transfusion (OR 2.96, 95% CI 2.14 - 4.09) compared to the control cohort, however risk of early GI bleed and late GI bleed was similar (Figure 1). Sub-group analysis showed patients who had sphincterotomy or combination therapy had a higher risk of late GI bleeding and blood transfusion compared to control cohort (Table 1). Sensitivity analysis did not show any difference in GI bleed outcomes with respect to age > 65, gender, thrombocytopenia, CKD stage >= 3, obesity and diabetes mellitus in the sphincterotomy group. Conclusion: Our findings suggest sphincterotomy should be avoided in patients on DaPT when P2Y12 receptor inhibitors cannot be stopped. The need for potential blood transfusion should be discussed with patients during informed consent. The higher risk of cardiac arrest could be related to temporary discontinuation of DaPT, delay in ERCP or underlying cardiovascular comorbidity, however this needs be further evaluated in future studies.Figure 1.: A. Demographics and mean ago of the study population. B. Group comparisons using a post hoc test.Table 1.: Study Methodology Quality Assessment on Newcastle-Ottawa Scale.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle