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Red blood cell transfusion following nonvariceal upper GI bleeding increases rebleeding
Patients who undergo red blood cell transfusion after experiencing nonvariceal upper gastrointestinal bleeding are at an elevated risk for rebleeding, according to recent results.
Researchers evaluated 1,677 patients with nonvariceal upper GI bleeding (NVUGIB). All participants were randomly collected from the Canadian Registry of patients with Upper Gastrointestinal Bleeding and Endoscopy. Clinical outcomes of patients who received red blood cell (RBC) transfusion (53.7% of the cohort) within 24 hours of presentation were compared against those who had not.
Rebleeding, defined as persistent bleeding or surgery in addition to rebleeding, occurred in 17.9% of the cohort. More patients who received transfusion experienced rebleeding than those who did not (23.6% vs. 11.3%, P<.01). Investigators observed an association between increased rebleeding risk and RBC transfusion after adjusting for confounders (adjusted OR=1.8; 95% CI, 1.2-2.8).
Other factors associated with rebleeding included fresh blood upon rectal examination (aOR=4.2; 95% CI, 2.4-7.4) or nasogastric tube aspirate (aOR=2.2; 95% CI, 1.4-3.5) and the presence of high-risk stigmata (aOR=4.4; 95% CI, 2.9-6.5). Proton pump inhibitors or endoscopic therapy, an initial hemoglobin level greater than 80 g/L and an ASA score of 1 or 2 were associated with decreased risk for rebleeding.
Death occurred in 5.4% of cases, with a higher rate of all-cause mortality among transfusion recipients (6.8% compared with 3.7%, P=.0045). Rebleeding was associated with increased mortality risk (OR=1.8; 95% CI, 1.0-2.9), while an ASA score of 1 or 2 decreased risk (OR=0.5; 95% CI, 0.3-0.9).
“The findings of our observational study suggest a clinically important and independent association between RBC transfusion and the subsequent risk of rebleeding after appropriate risk adjustment in NVUGIB patients,” the researchers wrote. “Although these results could be due to residual confounding, they ... support the need for a prospective randomized trial. Clinicians and expert consensus groups need to be aware of such considerations, as basic aspects of resuscitation are now being questioned and reassessed in many specialties across the world.”
Disclosure: See the study for a full list of relevant disclosures.