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There exists considerable practice variation and little evidence to guide red blood cell transfusion in patients with nonvariceal upper gastrointestinal bleeding. Studies in other critically ill cohorts suggest associations between transfusions and adverse patient outcomes. Dr Restellin and colleagues characterized any possible clinically-relevant association between red blood cell transfusion following nonvariceal upper gastrointestinal bleeding with rebleeding and mortality. The team performed an observational study utilizing the Canadian Registry of patients with upper gastrointestinal bleeding and endoscopy.  | | 54% received red blood cell transfusion | | Alimentary Pharmacology & Therapeutics |
The research team used multivariable logistic regression models to examine and quantify independent associations between red blood cell transfusion and clinical outcomes. Overall, 1677 patients were included. The team reported that 54% received red blood cell transfusion, 32% had haemodynamic instability, 5% fresh blood on rectal examination, and 9% in the nasogastric tube aspirate. The research team found that endoscopic hemostasis was performed in 35%. Overall rebleeding and mortality rates were 18% and 5%, respectively. After adjusting for potential confounders, transfusion of red blood cell within 24 hour of presentation was significantly and independently associated with an increased risk of rebleeding, but not death. Dr Restellin's team concludes "This study suggests an association between red blood cell transfusion following nonvariceal upper gastrointestinal bleeding and subsequent rebleeding, after appropriate and extensive adjustment for confounding." "Prospective randomized trial evidence is needed to identify the most efficacious and cost-effective transfusional strategies in these patients."
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