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Adherence to patient blood management strategy in patients with gastrointestinal bleeding: a prospective nationwide
Javier Tejedor-Tejada1, María Pilar Ballester2, Francisco Jose Del Castillo-Corzo3
1Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid.
Insights
Patient blood management (PBM) adherence is high and safe for gastrointestinal bleeding patients. Following PBM strategy improved patient outcomes, reducing mortality risk.
Area of Science:
- Hematology
- Gastroenterology
- Clinical Practice
Background:
- Assessing real-world patient blood management (PBM) adherence in clinical practice.
- Evaluating the management of gastrointestinal (GI) bleeding patients post-PBM strategy implementation.
Purpose of the Study:
- To assess the adherence and safety of the PBM strategy in patients with GI bleeding.
- To determine the impact of PBM adherence on patient outcomes.
Main Methods:
- Nationwide, multicenter, prospective study of adult GI bleeding patients (March 2019-March 2021).
- Patients categorized by admission hemoglobin (Hb) levels.
- Appropriate anemia/iron deficiency management defined as >75% adherence to PBM policy.
Main Results:
- 450 patients included; 55.1% received transfusion, 59.3% received iron supplementation.
- High adherence rates: 90.9% for transfusion, 81.8% for iron supplementation.
- PBM adherence did not correlate with length of stay or re-bleeding risk, but transfusion and iron supplementation were associated with lower mortality risk.
Conclusions:
- High adherence and safety of PBM observed in GI bleeding patients.
- PBM strategy adherence is linked to improved outcomes in GI bleeding management.
- Age and re-bleeding are significant negative prognostic factors.
Introduction:
Patient blood management (PBM) adherence in clinical practice is unclear. This real-world practice study assessed the management of patients with gastrointestinal (GI) bleeding after the implementation of the PBM strategy.
Methods:
This was a nationwide multicenter and prospective study involving consecutive adults with GI bleeding between March 2019 and March 2021. Patients were examined according to hemoglobin (Hb) level at admission (<7 g/dl, n = 93; 7-8 g/dl, n = 47; 8-9 g/dl, n = 61; and >9 g/dl, n = 249). Study outcomes measures were morbidity and mortality during hospitalization and at 3- and 6-month follow-up. Appropriate anemia or iron deficiency management was considered when adherence to PBM policy was higher than 75%.
Results:
A total of 450 patients (57.6% men, median age: 74 years, interquartile range: 63-82) were included. Overall, 55.1% and 59.3% of patients received transfusion and iron supplementation, respectively. The rates of appropriate transfusion and iron supplementation adherence were 90.9% (range: 86.9-93.5%, P = 0.109) and 81.8% (range: 78.5-85.1%, P = 0.041), depending on Hb level, respectively. No associations were observed between adherence to the PBM strategy and length of stay ( P = 0.263) or risk of further bleeding ( P = 0.742). Patients who were transfused [hazard ratio (HR): 0.79, 95% confidence interval (CI): 0.27-0.85] and iron supplemented (HR: 0.91, 95% CI: 0.38-1.41), however, appropriately achieved a lower risk of death. Age (HR: 1.12, 95% CI: 1.12-1.25) and further bleeding (HR: 39.08, 95% CI: 4.01-181.24) were poor prognostic factors. No serious adverse events were reported.
Conclusions:
In this nationwide study, there is a high level of adherence and safety of PBM for the treatment of GI bleeding. Adherence to the PBM strategy improved outcomes in patients with GI bleeding.
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