S814 The Clot Thickens - Hemostatic Powder as Primary Therapy in Non-variceal Upper Gastrointestinal Bleeding: An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials
Bibliographic record
Abstract
Introduction: Hemostatic powder (HP) has emerged as a potential therapeutic option in non-variceal upper gastrointestinal bleeding. However, the evidence regarding its efficacy and safety as primary therapy remains inconclusive. We aimed to evaluate the effectiveness of hemostatic powder in achieving primary hemostasis, reducing rebleeding rates, minimizing mortality, and assessing its impact on length of hospital stay (LOS) in patients with non-variceal upper gastrointestinal bleeding in a meta-analysis (Figure 1). Methods: We used the PubMed Scopus and Web of Science databases, through June 2023 to identify RCTs assessing the efficacy of HP compared with Standard of care (Hemoclip, thermocoagulation and epinephrine injection). We followed the (PRISMA) protocol. Two independent reviewers assessed study quality/risk for bias using Newcastle-Ottawa Scale (NOS) and extracted descriptive and quantitative data. Meta-analysis was performed using appropriate statistical methods to estimate pooled effect sizes, risk ratios, and heterogeneity. Results: The literature search yielded 2501 studies, of which 152 were identified for full-text review, with 7 studies filling the criteria for final analysis including 458 patients. HP primary hemostasis rates (99.34%, 95% CI: 97.13-100) compared to the controls (88.39%, 95% CI: 72.12-98.7), RR 1.06 (95% CI: 0.92-1.22), P=0.42. Rebleeding rates between the HP (12.98%, 95% CI: 3.72-25.71) and the controls (18.20%, 95% CI: 8.81-29.63), RR 0.95 (95% CI: 0.58-1.55) P=0.22. There were no significant differences in death rates between HP (16.63%, 95% CI: 2.78-37.01) and the control group (13.38%, 95% CI: 1.38-33.61), RR 1.11 (95% CI: 0.74-1.67) P=0.62. 5/7 studies reported LOS, the pooled analysis showed a mean difference of 2.67 days (95% CI: -0.68-6.02) longer in the HP group, although the difference was not statistically significant ( P=0.12). For all analysis done the Egger test suggested no significant presence of small-study effects in this meta-analysis (Table 1). Conclusion: The application of HP did not show significant risk ratios for achieving primary hemostasis when compared to the control group. Nevertheless, the HP group exhibited higher rates of primary hemostasis. There were no statistically significant risk ratios for rebleeding, death, and LOS, it is worth noting that rebleeding rates were lower in the treatment group. Further research is warranted to explore potential variations in these outcomes and to validate the findings of this meta-analysis.Figure 1.: Primary hemostasis with Hemostatic powder - Hazard rations. Table 1. - Primary Outcomes of Hemostatic Powder Treatment Outcome Rates in Hemostatic Powder Group Rates in Control Group Risk Ratio (95% CI) I2 of Risk Ratio (%) P-value Primary hemostasis 99.34% (97.13-100) 88.39% (72.12-98.7) 1.06 (0.92-1.22) 0.0% 0.42 Rebleeding 12.98% (3.72-25.71) 18.20% (8.81-29.63) 0.95 (0.58-1.55) 12.44% 0.22 Death 16.63% (2.78-37.01) 13.86% (1.38-33.61) 1.11 (0.74-1.67) 0.0% 0.62 Length of stay (days) Mean = 12.66 Mean = 10.88 MD:2.67 (-0.68-6.02) 21.41 0.12
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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 | 0.017 | 0.038 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.030 |
| Bibliometrics | 0.013 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 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".