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The New England Journal of Medicine Jan 2013The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy.
METHODS
We enrolled 921 patients with severe acute upper gastrointestinal bleeding and randomly assigned 461 of them to a restrictive strategy (transfusion when the hemoglobin level fell below 7 g per deciliter) and 460 to a liberal strategy (transfusion when the hemoglobin fell below 9 g per deciliter). Randomization was stratified according to the presence or absence of liver cirrhosis.
RESULTS
A total of 225 patients assigned to the restrictive strategy (51%), as compared with 61 assigned to the liberal strategy (14%), did not receive transfusions (P<0.001) [corrected].The probability of survival at 6 weeks was higher in the restrictive-strategy group than in the liberal-strategy group (95% vs. 91%; hazard ratio for death with restrictive strategy, 0.55; 95% confidence interval [CI], 0.33 to 0.92; P=0.02). Further bleeding occurred in 10% of the patients in the restrictive-strategy group as compared with 16% of the patients in the liberal-strategy group (P=0.01), and adverse events occurred in 40% as compared with 48% (P=0.02). The probability of survival was slightly higher with the restrictive strategy than with the liberal strategy in the subgroup of patients who had bleeding associated with a peptic ulcer (hazard ratio, 0.70; 95% CI, 0.26 to 1.25) and was significantly higher in the subgroup of patients with cirrhosis and Child-Pugh class A or B disease (hazard ratio, 0.30; 95% CI, 0.11 to 0.85), but not in those with cirrhosis and Child-Pugh class C disease (hazard ratio, 1.04; 95% CI, 0.45 to 2.37). Within the first 5 days, the portal-pressure gradient increased significantly in patients assigned to the liberal strategy (P=0.03) but not in those assigned to the restrictive strategy.
CONCLUSIONS
As compared with a liberal transfusion strategy, a restrictive strategy significantly improved outcomes in patients with acute upper gastrointestinal bleeding. (Funded by Fundació Investigació Sant Pau; ClinicalTrials.gov number, NCT00414713.).
Topics: Acute Disease; Adult; Erythrocyte Transfusion; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Gastroscopy; Hematemesis; Hemoglobins; Humans; Kaplan-Meier Estimate; Melena
PubMed: 23281973
DOI: 10.1056/NEJMoa1211801 -
Revista Espanola de Enfermedades... Nov 2023A 76-year-old man with multiple cardiovascular risk factors (hypertension, DM2, LD, smoker) and severe peripheral arterial disease (iliofemoral bypass, supracondylar...
A 76-year-old man with multiple cardiovascular risk factors (hypertension, DM2, LD, smoker) and severe peripheral arterial disease (iliofemoral bypass, supracondylar amputation) came to the emergency with coffee ground emesis and mild anemia. Urgent gastroscopy showed diffuse circumferential black mucosa covered by fibrin affecting the middle and distal esophageal third. Acute esophageal necrosis is a rare cause of gastrointestinal bleeding that should be suspected in patients with cardiovascular risk factors with an image of a black esophagus that is abruptly interrupted at the EGJ.
Topics: Male; Humans; Aged; Necrosis; Esophageal Diseases; Hematemesis; Gastrointestinal Hemorrhage; Acute Disease
PubMed: 36205331
DOI: 10.17235/reed.2022.9217/2022 -
Ugeskrift For Laeger Aug 2023In this case report, we present a 70-year-old male who was brought to our hospital with signs of upper gastrointestinal bleeding. The patient was diagnosed with aortitis...
In this case report, we present a 70-year-old male who was brought to our hospital with signs of upper gastrointestinal bleeding. The patient was diagnosed with aortitis two and a half months prior. We suspected upper gastrointestinal bleeding, and the patient was taken to the operating room for an acute endoscopy, which showed blood in the oesophagus, ventricle, and duodenum, but no bleeding source. CT angiography showed erosion of aortic aneurism, at the site of known aortitis, with bleeding into the lung and pleura. The patient was transported to the nearest university hospital for thoracic endovascular repair and survived.
Topics: Male; Humans; Aged; Hematemesis; Hemoptysis; Aortitis; Gastrointestinal Hemorrhage; Aortic Aneurysm; Hospitals, University
PubMed: 37767877
DOI: No ID Found -
British Medical Journal Jan 1968
Topics: Hematemesis; Humans
PubMed: 5634827
DOI: 10.1136/bmj.1.5586.253-c -
Revista Espanola de Enfermedades... Apr 2024A 65-year-old male complained of persistent melena for 6 days, and displayed anemia symptoms without hematemesis, vomiting, and abdominal distention. He was diagnosed as...
A 65-year-old male complained of persistent melena for 6 days, and displayed anemia symptoms without hematemesis, vomiting, and abdominal distention. He was diagnosed as ruptured aneurysm of aortic sinus Valsalva, and had received coronary artery occlusion 1 month ago. After the operation, he was continually prescribed clopidogrel 75 mg once daily. The laboratory examination showed blood hemoglobin concentration was 60 g/L without other conspicuous abnormality. Unfortunately, neither esophagogastroduodenoscopy (EGD) nor colonoscopy found no obvious bleeding lesions. And abdominal computed tomography angiography (CTA) and enhanced computed tomography (CT) showed no obvious abnormal findings. Moreover, capsule endoscopy revealed small intestinal with mucosal erosion (Figure 1A). After discontinued clopidogrel, blood transfusion, and support therapy, his symptoms was resolved with negative fecal occult blood, continued clopidogrel 75 mg once daily, and uneventfully discharged 1 week later.
Topics: Male; Humans; Aged; Clopidogrel; Gastrointestinal Hemorrhage; Melena; Hematemesis; Colonoscopy
PubMed: 37114388
DOI: 10.17235/reed.2023.9659/2023 -
Revista Espanola de Enfermedades... Apr 202459-year-old man, smoker, diabetic and hypertensive. He went to the ER due to fixed abdominal pain in the epigastrium, diaphoresis, dizziness, nausea, and "coffee...
59-year-old man, smoker, diabetic and hypertensive. He went to the ER due to fixed abdominal pain in the epigastrium, diaphoresis, dizziness, nausea, and "coffee grounds" vomiting. On examination he presented abdominal distension and pain on palpation in the epigastrium, without peritonism. He had a BP of 235/100 mmHg and in the blood-tests, leukocytosis with neutrophilia and normal hemoglobin. An urgent abdominal CT scan was performed, identifying a 5x6 cm nodular lesion of homogeneous density attached to the wall of the second and third duodenal portions that compressed the lumen, with two vessels with active bleeding within it. Therefore, percutaneous embolization of the gastroduodenal artery was performed. Subsequently, the patient suffered an episode of severe acute pancreatitis that required ICU admission. Finally, he presented a good clinical evolution with ceasing of pain, complete reabsorption of the hematoma and resolution of the obstructive symptoms.
Topics: Male; Humans; Acute Disease; Pancreatitis; Hematoma; Duodenal Diseases; Gastrointestinal Hemorrhage; Abdominal Pain; Hematemesis
PubMed: 37706445
DOI: 10.17235/reed.2023.9793/2023 -
Thorax Sep 1969Death from haematemesis is recorded in a patient with a giant left atrium which had caused dysphagia of such severity that a plastic naso-gastric feeding tube had been...
Death from haematemesis is recorded in a patient with a giant left atrium which had caused dysphagia of such severity that a plastic naso-gastric feeding tube had been introduced and retained for some days. Vascular causes of dysphagia are briefly reviewed. It is thought that the rarity of dysphagia with left atrial enlargement justifies its recognition by a new term.
Topics: Adult; Cardiomegaly; Deglutition Disorders; Esophageal Perforation; Female; Heart Atria; Hematemesis; Humans; Rupture, Spontaneous; Vascular Diseases
PubMed: 4242328
DOI: 10.1136/thx.24.5.603 -
British Medical Journal Sep 1947
PubMed: 20787192
DOI: No ID Found -
The Journal of Thoracic and... Sep 2017
Topics: Aged; Aortic Aneurysm, Thoracic; Aortic Diseases; Blood Vessel Prosthesis; Endovascular Procedures; Esophageal Fistula; Female; Foreign-Body Migration; Hematemesis; Humans; Tomography, X-Ray Computed; Vascular Fistula
PubMed: 28666658
DOI: 10.1016/j.jtcvs.2017.04.075 -
Hong Kong Medical Journal = Xianggang... Dec 2011
Topics: Aged, 80 and over; Endoscopy, Digestive System; Female; Hematemesis; Humans; Melanoma; Skin Neoplasms; Stomach Neoplasms
PubMed: 22147324
DOI: No ID Found