Introduction: Liver cirrhosis is being increasingly recognized as a hypercoagulable state, mainly due to disproportionate reduction in antithrombotic factors (protein C, S and anti-thrombin III). Portal vein thrombosis (PVT) is a frequent sequala of liver cirrhosis that can lead to numerous complications and potential exclusion from transplant lists, at least until the resolution of the thrombus. The current evidence for anticoagulation (AC) for PVT in liver cirrhosis is limited to small retrospective studies. Major liver societies recommend limited anticoagulation with enoxaparin based on expert opinion (Category C). We sought to examine the incidence of bleeding after AC in cirrhotic patients with PVT. Methods: Data were obtained from a commercial de-identified database (Explorys, IBM, Inc.) that integrates electronic health records from 27 major integrated U.S. healthcare systems from 1999 to July 2019. Cases were defined as adult patients aged >=18 years having a new Systematized Nomenclature of Medicine Clinical Terms (SNOMED) diagnosis of PVT, had been anticoagulated for the first time following PVT and had experienced bleeding for the first time following AC. Controls were adults who had a diagnosis of PVT and did not get AC. We included older anticoagulants (warfarin and enoxaparin) as well as newer anticoagulants (apixaban, fondaparinux and rivaroxaban). We compared the incidence of bleeding (defined as bleeding from any site) in those with PVT who received AC to those with PVT who did not receive AC. In addition, we also compared the incidence of bleeding between older and newer anticoagulants, and also examined whether there were differences in gender, race, and insurance status for those who bled while on AC. Analysis comprised of calculating odds ratios (OR) and confidence intervals (CI) for the OR. Results: A total of 213,810 patients had liver cirrhosis and out of those, 7,570 (3.5%) patients had PVT. Four hundred and ten cases out of 1,430 patients who received AC bled for the first time whereas 980 cases out of 3,880 patients who did not receive AC bled for the first time. Cases on AC had 1.18 times higher odds of bleeding when compared to controls who did not receive AC (CI = 1.04 - 1.36). Newer AC were less likely to increase bleeding when compared to older AC (OR = 0.6, CI = 0.4 - 0.9). Females were significantly more likely to be first time bleeders on AC when compared to male first-time bleeders on AC (Table 1). However, race and insurance status did not seem to affect bleeding rates (Table 1). Conclusion: Anticoagulation for PVT in liver cirrhosis increases bleeding events. Newer AC were significantly less likely to increase bleeding when compared to older AC. Females were more likely to bleed on newer AC than males, but race and insurance status did not affect bleeding rates. Limitations of the study include the retrospective nature of the analysis that relied on diagnosis coding, and smaller numbers in our subgroup analyses which limits generalizability. Clinicians should be aware of the significant risk of bleeding when prescribing AC, particularly older AC to cirrhotic patients with PVT. Disclosures No relevant conflicts of interest to declare.
Introduction: T2DM and HIV independently confer an increased risk of CV adverse events. We aimed to evaluate the effect of newer oral antidiabetic medications (GLP-1 RA/SGLT2i) on CV outcomes in adults with HIV and T2DM. Methods: Using a national database (IBM Explorys Solutions, IBM, Inc.), we searched for cases (HIV + T2DM patients on GLP-1 RA/SGLT2i and metformin) and controls (HIV + T2DM patients on metformin alone). We calculated comparative odds ratios (OR) and 95% confidence interval (CI) for the risk of association of GLP-1 RA/SGLT2i use and incident CV adverse events, namely myocardial infarction (MI) and acute heart failure (AHF). Results: Out of a total of 61,917,780 patients in Explorys, 29,920 had both HIV and T2DM. Patients on GLP-1 RA or SGLT2i were significantly less likely to experience an incident adverse CV event when compared to controls (Table 1). When stratified by individual drug classes (either GLP-1 RA or SGLT2i), patients on the newer antidiabetic medications were still significantly less likely to experience an adverse CV event in comparison to metformin alone (Table 1). Conclusion: GLP-1 RA and SGLT2i seem to confer a protective effect against major adverse CV events such as MI and AHF in patients with both HIV and T2DM. Disclosure O.A. Alaber: None. A.K. Chandar: None. B.A. Dahash: None. A.C. Zuzek: None. A. Rajpal: None.
INTRODUCTION: Eosinophilic esophagitis (EoE) and asthma are two common chronic conditions that are closely related and likely mediated by similar immunopathologic mechanisms and can be treated with similar treatment modalities. We aimed to examine the association of EoE with asthma using a large nationwide hospital database. We additionally examined the association of EoE with other related allergic-immunologic conditions such as allergic urticaria, eczema, allergic conjunctivitis, allergic rhinitis, and food and environmental allergies. METHODS: Data were obtained from a commercial de-identified patient database (Explorys, IBM, Inc.) that integrates electronic health records from 26 major U.S. hospital systems from 1999 to June 2019. Inclusion criteria for cases was all patients with a Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) diagnosis of asthma whereas inclusion criteria for controls was patients without asthma. Odds ratios (OR) and confidence intervals (CI) were calculated for the association of EoE with asthma and other related allergic-immunologic conditions. RESULTS: A total of 3,459,740 cases had asthma. Out of these, 4,490 had a diagnosis of EoE which followed in time the diagnosis of asthma. Out of 33,336,680 controls without asthma in the database, 20,390 had a diagnosis of EoE. When compared to controls without asthma, cases with asthma had a 2 (95% CI = 2.06 - 2.19) times higher odds of receiving a diagnosis of EoE following their asthma diagnosis. Similarly, other allergic-immunologic conditions were associated with a much higher odds of having EoE (Table 1). Patients with severe asthma had a 1.75 (CI = 1.37 - 2.23) times greater odds of having EoE when compared to patients with less severe (i.e. mild or moderate) asthma. CONCLUSION: There is a higher tendency for EoE to be diagnosed in patients with asthma and other allergic-immunologic conditions. In addition to being a retrospective analysis, inability to fully validate SNOMED-CT codes and unavailability of histology for the diagnosis of EoE could limit generalizability of the study. Nevertheless, patients with pre-existing asthma or allergic-immunologic conditions and symptoms suggestive of EoE (dysphagia, acid reflux or feeding difficulties) may warrant endoscopic evaluation.
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