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World Journal of Surgery

, Volume 40, Issue 5, pp 1129–1136 | Cite as

Effect of Transfusion Strategy in Acute Non-variceal Upper Gastrointestinal Bleeding: A Nationwide Study of 5861 Hospital Admissions in Denmark

  • Rasmus Fabricius
  • Peter Svenningsen
  • Jens Hillingsø
  • Lars Bo Svendsen
  • Martin Sillesen
Original Scientific Report

Abstract

Background

Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of admissions as well as aggressive transfusion of blood products. Whether the transfusion strategy in NVUGIB impacts on hemostasis is unknown and constitutes the focus of this study.

Method

Retrospective analysis of all hospital admissions in Denmark between 2011 and 2013 where hemostatic endoscopic interventions in either the stomach or duodenum had been employed. Regression modeling was used to predict the effect of units transfused of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT) on primary outcome 30-day mortality as well as secondary hemostasis-related outcomes and need for re-endoscopy and conversion to surgery. The model was corrected for confounders, including transfusion of other blood products (PRBC, FFP, and PLT, respectively), patient age as well as pre-existing medical conditions.

Results

5107 patients received 10783 therapeutic endoscopic interventions. Units of PRBC transfused were identified as a predictor of re-endoscopy, surgery, and 30-day mortality with odds ratio (OR) 1.08 (1.06–1.09, p < 0.01), 1.05 (1.03–1.07, p < 0.01), and 1.04 (1.01–1.06, p < 0.01), respectively. Units of FFP transfused were associated with a higher risk of surgery and 30-day mortality with OR 1.05 (1.02–1.08, p < 0.01) and 1.04 (1.02–1.07, p < 0.01), respectively. Units of PLTs transfused were independently associated with a reduction in risk of re-endoscopy 0.93 (0.87–0.98, p = 0.02). A high ratio of PRBC:FFP:PLT (1:1:1) was associated with reduced need for re-endoscopy OR 0.23 (0.06–0.67, p = 0.01) but increased mortality with OR 3.60 (1.34–11.38, p = 0.02).

Conclusion

PRBC transfusion was associated with adverse events, including 30-day mortality and failure of hemostasis. In contrast, transfusion of PLT was associated with a reduction in need for re-endoscopy.

Keywords

Fresh Freeze Plasma Massive Transfusion National Patient Registry Plasma Transfusion Transfusion Strategy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Author contributions

Martin Sillesen, Rasmus Fabricius, Peter Svenningsen, Lars Bo Svendsen, and Jens Hillingsø contributed to study design and critical revisions of the manuscript. Martin Sillesen, Rasmus Fabricius and Peter Svenningsen further contributed to data analysis and manuscript preparation.

Compliance with ethical standards

Conflicts of interest

None.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  1. 1.Department of SurgeryCopenhagen University HospitalHillerødDenmark
  2. 2.Department of Surgical Gastroenterology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark

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