Red blood cell transfusion is associated with increased rebleeding in patients with nonvariceal upper gastrointestinal bleeding
Article first published online: 3 DEC 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 37, Issue 3, pages 316–322, February 2013
How to Cite
Aliment Pharmacol Ther 2013; 37: 316–322
- Issue published online: 2 JAN 2013
- Article first published online: 3 DEC 2012
- Manuscript Accepted: 12 NOV 2012
- Manuscript Revised: 7 NOV 2012
- Manuscript Revised: 27 OCT 2012
- Manuscript Received: 8 OCT 2012
- Canadian Association of Gastroenterology
There exists considerable practice variation and little evidence to guide red blood cell (RBC) transfusion in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). Studies in other critically ill cohorts suggest associations between transfusions and adverse patient outcomes.
To characterise any possible clinically-relevant association between RBC transfusion following NVUGIB with rebleeding and mortality.
Observational study utilising the Canadian Registry of patients with Upper Gastrointestinal Bleeding and Endoscopy (RUGBE). Multivariable logistic regression models were used to examine and quantify independent associations between RBC transfusion and clinical outcomes.
Overall, 1677 patients were included (66.2 ± 16.8 years, 61.7% male, 2.5 ± 1.7 comorbid conditions, initial haemoglobin, 96.8 ± 27.2 g/L); 53.7% received RBC transfusions (2.9 ± 1.6 units of blood), 31.6% had haemodynamic instability, 5.1% fresh blood on rectal examination and 8.6% in the nasogastric tube aspirate. Endoscopic haemostasis was performed in 35.2%. Overall rebleeding (defined as continuous bleeding, rebleeding or surgery) and mortality rates were 17.9% and 5.4%, respectively. After adjusting for potential confounders, transfusion of RBC within 24 h of presentation was significantly and independently associated with an increased risk of rebleeding (OR: 1.8, 95% CI: 1.2–2.8), but not death (OR: 1.0, 95% CI: 0.6–1.8).
This study suggests an association between RBC transfusion following NVUGIB and subsequent rebleeding, after appropriate and extensive adjustment for confounding. Prospective randomised trial evidence is needed to identify the most efficacious and cost-effective transfusional strategies in these patients.