Haematological risk factors predicting clinical success in transarterial embolisation for acute gastrointestinal bleeding

Abstract

Objectives: Evaluate clinical outcomes in transarterialembolisation (TAE) for acute gastrointestinal bleeding (GIB) and determine risk factors for 30 day reintervention for rebleeding and mortality. Methods: TAE cases were retrospectively reviewed between March 2010–September 2020 at our tertiary centre. Technical success (angiographic haemostasis following embolisation) was measured. Univariate and multivariate logistic regression analysis were performed to identify risk factors for clinical success (absence of 30 day reintervention or mortality) following embolisation for active GIB or empirical embolisation for suspected bleeding. Results: TAE was conducted in 139 patients (92 (66.2%) male; median age:73, range: 20–95 years) for acute upper GIB (n = 88) and lower GIB (n = 51). TAE was technically successful in 85/90 (94.4%) and clinically successful in 99/139 (71.2%); with 12 (8.6%) reintervention cases for rebleeding (median interval 2 days) and 31 (22.3%) cases of mortality (median interval 6 days). Reintervention for rebleeding was associated with haemoglobin drop >40 g l−1 from baseline based on univariate analysis (p = 0.047). 30 day mortality was associated with pre-intervention platelet count <150×109/L (p < 0.001, OR7.35, 95% CI 3.05–17.71) and INR >1.4 (p < 0.001, OR4.75, 95% CI 2.03–11.09) on multivariate logistic regression analysis. No associations were found for patient age, gender, antiplatelet/anticoagulation prior to TAE, or when comparing upper and lower GIB with 30 day mortality. Conclusions: TAE had excellent technical success for GIB with relatively high (1-in-5) 30 day mortality. INR >1.4 and platelet count <150×109/L were individually associated with TAE 30 day mortality, and pre-TAE >40 g l−1 haemoglobin decline with rebleeding requiring reintervention. Advances in knowledge: Recognition and timely reversal of haematological risk factors may improve TAE peri-procedural clinical outcomes.