A209 ENDOSCOPY BLEEDING RISK IN PATIENTS WITH INHERITED COAGULATION DISORDERS, A RETROSPECTIVE STUDY
Bibliographic record
Abstract
Hemophilia A and B and Von Willebrand Disease (VWD) are congenital bleeding disorders which respectively lead to factor VIII (F8) and factor IX (F9) deficiency and Von Willebrand Factor defects. Rarer bleeding disorders include factor VII (F7) and factor XI (F11) deficiency. These diseases predispose to bleeding adverse events, especially during medical interventions. The bleeding risk of these patients when undergoing a gastrointestinal endoscopy is unknown and has only been estimated in small case series. To mitigate the bleeding risk, peri-procedure treatment with factor concentrates, DDAVP and tranexamic acid is advocated. The primary outcome of this study is to determine the point estimate of bleeding events within 72 hours of gastrointestinal endoscopy on a cohort of patients with inherited bleeding diatheses. The secondary outcome aims to establish predictors of bleeding in this cohort and to evaluate whether peri-procedure treatments helps prevent such complications. Data on 131 endoscopies performed on patients with hemophilia A or B, VWD, F7 or F11 deficiency was retrospectively collected. Demographic parameters, biochemical markers of disease severity and bleeding risk, peri-endoscopic treatments received and complications of the procedure were collected. Endoscopies were excluded from analysis if indication for procedure was bleeding. Point estimate of 72-hour bleeding rate was calculated and a univariate analysis was performed to assess for predictors of bleeding risk. 104 endoscopies were eligible for analyses and another 27 were excluded given bleeding as indication for procedure. Endoscopy was performed on 62 patients with 21 female and 41 male patients. Hemophilia A comprised the majority of patients at 44%, followed by VWD at 40%, F11 deficiency at 11%, hemophilia B at 5% and F7 deficiency at 4%. The point estimate of 72-hour bleeding rate was 0.96% (95% confidence interval 0.92–1.00%). 50% of endoscopies were accompanied by use of factor concentrates, DDAVP or tranexamic acid. 24% of endoscopies included a higher risk procedure such as polypectomy. Inferential testing via univariate analyses between bleeding risk and demographic parameters, coagulation parameters, type of endoscopic procedure and medications were non-significant. This is the largest cohort to show that gastrointestinal endoscopy can be performed safely in patients with inherited coagulation disorders if peri-procedure treatment to enhance hemostasis is provided. The very low incidence of bleeding complications limited further inferential statistical analysis. Larger studies are required to assess for predictors of bleed and to evaluate the role of peri-procedure treatment with factor concentrates, DDAVP or tranexamic acid. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".