Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 10 December 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Predicting risk of upper GI bleed and intracranial bleed with anticoagulants

This week's issue of the British Medical Journal predicts risk of upper gastrointestinal bleed and intracranial bleed with anticoagulants.

News image

Drs Julia Hippisley-Cox and Carol Coupland developed and validated risk algorithms (QBleed) for estimating the absolute risk of upper gastrointestinal and intracranial bleed for patients with and without anticoagulation aged 21-99 years in primary care.

The research team performed an open cohort study using routinely collected data from general practice linked to hospital episode statistics data and mortality data during the five year study period between 2008 and 2013.

The team evaluated 565 general practices in England contributing to the national QResearch database to develop the algorithm, and 188 different QResearch practices to validate the algorithm.

All 753 general practices had data linked to hospital episode statistics, and mortality data at individual patient level.

The team's endpoint was gastrointestinal bleed and intracranial bleed recorded on either the linked mortality data or the linked hospital records.

Sensitivity value for the top 10th of women at highest risk was 51%
British Medical Journal

The researchers studied 4.4 million patients in the derivation cohort with 16.4 million person years of follow-up.

During follow-up, 21 641 patients had an incident upper gastrointestinal bleed, and 9040 had an intracranial bleed.

For the validation cohort, the team identified 1.4 million patients contributing over 4.9 million person years of follow-up.

During follow-up, 6600 patients had an incident gastrointestinal bleed, and 2820 had an intracranial bleed.

The team excluded patients without a valid Townsend score for deprivation, and those prescribed anticoagulants in the 180 days before study entry.

Risk factors Candidate variables recorded on the general practice computer system before entry to the cohort, including personal variables, lifestyle variables, chronic diseases, prescribed drugs, clinical values, and laboratory test results.

The researchers also included previous bleed recorded before entry to the study.

The final QBleed algorithms incorporated 21 variables.

The team found that when applied to the validation cohort, the algorithms in women explained 40% of the variation for upper gastrointestinal bleed, and 58% for intracranial bleed.

The corresponding D statistics were 1.67 and 2.42.

The researchers noted that the receiver operating curve statistic values were 0.77 and 0.86.

The sensitivity values for the top 10th of men and women at highest risk were 38% and 51%, respectively.

The research team observed similar results for men.

Dr Hippisley-Cox and colleague conclude, "The QBleed algorithms provided valid measures of absolute risk of gastrointestinal, and intracranial bleed in patients with and without anticoagulation as shown by the performance of the algorithms in a separate validation cohort."

"Further research is needed to evaluate the clinical outcomes and the cost effectiveness of using these algorithms in primary care."

BMJ 2014;349:g4606
11 August 2014

Go to top of page Email this page Email this page to a colleague

 09 December 2016 
Use of GI alarm features for colorectal cancer diagnosis
 09 December 2016 
Emergency department use by IBD patients
 09 December 2016 
PPI regimens for upper GI bleeds
 08 December 2016 
Preterm birth in women with IBD
 08 December 2016 
Precision medicine in IBD
 08 December 2016 
Intestinal tuberculosis vs Crohn's disease
 07 December 2016 
Iron deficiency in ulcerative colitis
 07 December 2016 
IBD source of information and patient education
 07 December 2016 
End-of-rotation resident transition and in-hospital mortality
 06 December 2016 
Anti-TNF therapy for IBD
 06 December 2016 
Crohn's disease and thyroid cancer risk
 06 December 2016 
IBD Disability Index in restorative proctocolectomy
 05 December 2016 
Reducing hospitalization in IBD
 05 December 2016 
Disease mangement in IBD
 05 December 2016 
New biomarkers for IBD diagnosis
 02 December 2016 
Hep E in acute liver failure
 02 December 2016 
Occurrence and severity of alcoholic hepatitis
 02 December 2016 
Food antigen in active eosinophilic esophagitis
 01 December 2016 
Iron deficiency in anemic ulcerative colitis patients
 01 December 2016 
Prognostic factors after paracetamol-induced liver failure
 01 December 2016 
Factors that influence colorectal cancer screening findings
 30 November 2016 
Certolizumab pegol in Crohn's disease
 30 November 2016 
Genetic risk of Crohn's in chronic granulomatous disease
 30 November 2016 
Rifaximin in diarrhea-predominant IBS
 29 November 2016 
Assessing liver steatosis
 29 November 2016 
Treating Zenker's diverticulum
 29 November 2016 
Colorectal cancer surveillance in ulcerative colitis
 28 November 2016 
Complications in celiac disease
 28 November 2016 
Monitoring IBD with mobile technology
 28 November 2016 
Reducing warfarin-related upper GI bleeds
 25 November 2016 
Metal vs plastic stents for pancreatic cancer surgery
 25 November 2016 
Yoga and IBS therapy 
 25 November 2016 
Colorectal cancer screening issues
 24 November 2016 
Partner burden in celiac disease
 24 November 2016 
Fusobacterium nucleatum for colorectal cancer prognosis
 24 November 2016 
PPIS and gastric cancer risk
 23 November 2016 
Quality assurance standards for colonoscopy
 23 November 2016 
Diagnosing autoimmune pancreatitis
 23 November 2016 
Readmissions in cirrhosis
 22 November 2016 
Bile acid diarrhea in function bowel disorder with diarrhea
 22 November 2016 
Fatigue in IBD
 22 November 2016 
PPIs and C. diff in ICU 
 21 November 2016 
Pain after endoscopic resection of gastric tumors
 21 November 2016 
Antivirals and chemotherapy in Hep C patients with cancer
 21 November 2016 
Financial incentives and colorectal cancer screening
 18 November 2016 
Colorectal cancer risk and self-reported family history
 18 November 2016 
Ustekinumab in Crohn’s disease
 18 November 2016 
Antivirals and chemotherapy in Hep C patients with cancer
 17 November 2016 
Liver-related specialty care in patients with Hep C
 17 November 2016 
Risk of overweight in infants
 17 November 2016 
Moderate alcohol consumption and NAFLD
 16 November 2016 
PPI therapy in liver disease
 16 November 2016 
Education in Gastroenterology fellowship
 16 November 2016 
Paternal preconceptional use of anti-TNF-α agents
 15 November 2016 
Novel treatment of NASH 
 15 November 2016 
Contraceptives and ulcerative colitis
 15 November 2016 
Physician perspectives on Hep C management
 14 November 2016 
Cardiovascular risk in NAFLD 
 14 November 2016 
Vit D and NAFLD
 14 November 2016 
Malignancy risk in IBD 

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us