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 21 February 2018

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News

Does transfusion effectively counter antiplatelet agents in gastrointestinal bleeding?

This month's issue of Clinical Gastroenterology & Hepatology finds no benefit from platelet transfusion for gastrointestinal bleeding in patients taking antiplatelet agents.

News image

Antiplatelet agents decrease cardiovascular events but increase gastrointestinal bleeding. 

Guidelines propose platelet transfusion for patients who take antiplatelet agents and have serious gastrointestinal bleeding. 

Dr Loren Laine and colleagues from Connecticut, USA investigated whether such patients are at decreased risk for rebleeding or increased risk for cardiovascular events after platelet transfusion.

The researchers performed a retrospective cohort study of patients with gastrointestinal bleeding admitted to Yale-New Haven Hospital from 2008 to 2013 who were taking antiplatelet agents and had platelet counts higher than 100 × 109/L. 

Cases were matched with controls for sex, age, and gastrointestinal bleeding location. 

The team's primary outcome was recurrent gastrointestinal bleeding. 

The research team performed multivariable regression analyses to adjust for differences in baseline characteristics.

The adjusted odds ratio for recurrent bleeding was 1.47
Clinical Gastroenterology & Hepatology
The team found that cases and controls had similar proportions of gastrointestinal bleeding due to non-variceal upper gastrointestinal bleeding, and colonic gastrointestinal bleeding. 

The research team observed that cases had more severe gastrointestinal bleeding than controls, which was based on lower blood pressure and hemoglobin levels and higher heart rates, and the proportion admitted to intensive care. 

The team showed that higher proportions of cases had major cardiovascular events, died, or had hospital stay longer than 4 days. 

However, the researchers showed a significant difference between cases and controls in only risk of death. 

The team found that the adjusted odds ratio for recurrent bleeding was 1.47 for cases vs controls.

Dr Laine's team concludes, "The use of platelet transfusions in patients with gastrointestinal bleeding who are taking antiplatelet agents without thrombocytopenia did not reduce rebleeding but was associated with higher mortality."

"At least some of the increase in mortality could be due to the residual bias of an observational study, but because of the lack of benefit, we do not support the use of platelet transfusions in patients with gastrointestinal bleeding who are taking antiplatelet agents."

Clin Gastroenterol Hepatol 2017: 15(1): 46–52 
04 January 2017

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