Introduction

Restarting anticoagulation (AC) therapy following acute gastrointestinal bleeding (GIB) is a multidisciplinary, personalized decision. Current guidelines recommend resuming AC, though data on the optimal timing is limited.

Aims & Methods

Our aim is to assess the short-term effect of early and delayed AC therapy resumption.
We analyzed the data of the Hungarian GIB Registry (a multicenter, prospective database) between 2019-2022. Patients were included after successful management of AC-related GIB. Detailed medical and drug history, demographics, and data on the index bleeding and management (bleeding source, endoscopic, and medical therapy) were collected. 30 and 90-day rebleeding, thromboembolic (TE) complications, all-cause, and 30-day recurrent GIB or TE-related mortality were assessed in the early (≤ 7 days) and delayed (>7 days) AC resumption groups.

Results

218 cases were analyzed. Except for the CHA₂Ds₂-VASc score (mean (SD) 5.19 (1.65) vs 4.37 (1.549); p=0.02), the main characteristics (e.g., age, Charlson comorbidity index, active malignancy, anamnestic previous GIB, co-medications, HAS-BLED score, hemodynamic instability, high-risk bleeding site, endoscopic intervention) were similar between the two groups. Delayed AC therapy resumption was not associated with decreased 30-day rebleeding risk (5.3% vs. 6.7%; HR = 1.26, 95%CI 0.27-5.77, p=0.76). Delayed resumption was not associated with a higher 90-day TE complications rate (2.1% vs. 6.6%; HR = 3.17, 95%CI 0.58-17.33, p=0.18). Recurrent GIB-related 30-day mortality occurred only in one case (early resumption group, 12 days after admission with index bleeding). TE-related mortality was not observed during the follow-up.

Conclusion

Anticoagulation resumption in the first seven days after GIB was proven to be safe, which supports the suggestion of the actual European guidelines. Further research on separated bleeding sources and types of anticoagulants is needed.

Disclosure

Authors do not have any conflict of interest to disclose.

Introduction

Anemia is a common and often underdiagnosed condition in the elderly population. Digestive endoscopy plays a pivotal role in the etiological workup, particularly to rule out serious underlying causes such as malignancies or peptic lesions. However, the diagnostic yield of such procedures in routine clinical practice remains variable and underreported, especially in resource-limited settings.

Aims & Methods

To assess the diagnostic yield of digestive endoscopy in the investigation of anemia in elderly patients, with a particular focus on iron deficiency anemia (IDA) and vitamin B12 deficiency, and to identify specific endoscopic findings associated with these etiologies.
We conducted a retrospective descriptive study over a 6-month period. The study included all patients aged 65 years and older who underwent esophagogastroduodenoscopy (EGD) and/or colonoscopy as part of the diagnostic evaluation for anemia. Data collected included demographic information, clinical symptoms, laboratory parameters (including hemoglobin, ferritin, vitamin B12 levels), endoscopic findings, and histopathological results when available.

Results

A total of 252 patients were included in the analysis. Among them, 44 patients (17.5%) with a mean age of 71 years [68-82], had confirmed IDA, and six patients (2.4%) presented with vitamin B12 deficiency anemia, associated in all cases with histologically confirmed fundic atrophy.
In univariate analysis, IDA was statistically correlated with the presence of peptic esophagitis (p=0.04), gastric neoplasia (p=0.001), erosive gastropathy (p=0.02), and Helicobacter pylori gastritis (p=0.04). It was also weakly correlated with the presence of colorectal cancer (p=0.05).
Colonic angiodysplasias and colonic polyps were not associated with IDA in this cohort (p=0.1 and p=0.4, respectively).

Conclusion

Digestive endoscopy, particularly EGD, remains a cornerstone in the diagnostic algorithm of anemia in the elderly. It enables the identification of a wide range of underlying pathologies, from inflammatory lesions to malignancies, and guides appropriate therapeutic interventions. Early endoscopic evaluation should be encouraged in this population to prevent diagnostic delays and improve outcomes.

Introduction

Cirrhotic cardiomyopathy (CCM), cardiac dysfunction in liver cirrhosis of any aetiology in the absence of a primary cardiac cause predisposes to morbidity and mortality before and after Liver Transplantation (LT). Global longitudinal strain (GLS) measurement is included in the updated CCM criteria to detect subclinical myocardial dysfunction. Myocardial work (MW) is a novel echocardiographic measure, combining GLS with simultaneous blood pressure measurements has been found to correlate well with invasively measured global myocardial function. MW is not reported in cirrhosis and CCM.

Aims & Methods

The primary aim was to evaluate global cardiac function in decompensated cirrhosis using advanced echocardiographic parameters at rest and with dobutamine stress echo (DSE), and to study their association with development of a composite clinical outcome including acute kidney injury/hepatorenal syndrome, refractory ascites, cardiac failure and death over the subsequent 12 months. The secondary aims were to report the prevalence of CCM and to assess its association with the study outcome; to assess the diagnostic utility of cardiac biomarkers (NT-pro-BNP and cardiac troponin T) in CCM, and re-assess cardiac function at 12 months of successful LT.
Prospective study of cirrhotic patients with ascites or undergoing LT assessment from January 2021 to August 2022, with 12-month follow-up. After a written consent, clinical profile, Model for End-stage Liver Disease sodium (MELD Na) score, and cardiac biomarkers were evaluated. Transthoracic echo and DSE measured GLS and calculated MW (GWI (global work index), GCW (global constructive work), GWE (global work efficiency) and GWW (global wasted work). Statistical analysis was conducted using SPSS IBM Statistics version 29. Difference in estimated marginal mean difference in MW between baseline and DSE were obtained using repeated measures of ANOVA. Univariate analysis of clinical, echocardiographic and demographic features on the study outcome was assessed using either independent t-test or chi-squared test as appropriate. Significant predictors from the univariate analysis (p<0.05) were included in multivariate Cox regression analysis.

Results

96 patients with mean±SD age 56±11 years; (58% male; 59% alcohol misuse) were studied. The mean±SD MELD Na was 17±11. 16 patients underwent LT; 53 developed the composite clinical outcome. MELD Na, troponin, LVEF, rest and peak GLS, rest and peak GWI, peak GWE and E/e’ were significantly higher in patients meeting study outcome in univariate analysis. MELD Na and E/e’ were positively associated in multivariate analysis with HR (95%CI)=1.075:1.018–1.135; p=0.009 and HR=1.179; 1.037–1.340; p=0.012 respectively. There was a significant decrease in GLS and MW on DSE. There was a significant correlation between MELD Na and rest GLS (r=0.30, p<0.001). Based on new CCM criteria, systolic dysfunction was detected in 17% and diastolic dysfunction in 13% and CCM in 27%. There was no association between CCM and the composite study outcome. Median (IQR) troponin was 13.5 ng/ml (7.0–24.0) and BNP was 189 (pg/ml) (53.0–374.0). There was no association between these biomarkers and CCM. Ten patients evaluated post LT, demonstrated significant improvements in GLS, MW and LVEF.

Conclusion

In our patients with advanced cirrhosis, the study revealed increased myocardial work without any augmentation on DSE. CCM observed in a quarter of patients, had no impact on clinical course before/ after LT. Further studies are warranted to validate the updated CCM criteria and improve its clinical utility.

Disclosure

no cnfict t if interest