SAN ANTONIO – Patients with bleeding gastrointestinal angiodysplasias who are receiving antithrombotic therapy have a lower probability of rebleeding when treated with hemoclips (in combination or as monotherapy), compared with the use of argon plasma photocoagulation. This finding was presented at the ACG 2019 Annual Scientific Meeting, held October 25-30, 2019, in San Antonio, Texas.

The investigators of this retrospective study sought to analyze the rebleeding rate using hemoclips vs argon plasma photocoagulation to treat patients with bleeding gastrointestinal angiodysplasias. The study included 178 adults with bleeding gastrointestinal angiodysplasias receiving care at any Cleveland Clinic hospital between 2009 and 2016; only patients who resumed antithrombotic therapy following the intervention were included in the final analysis.

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Of these 178 individuals, 92 received argon plasma photocoagulation, 28 received hemoclips as monotherapy, and 58 received hemoclips in combination with a second modality; all participants were followed for a median 18.5 months. Baseline characteristics were similar among the groups except for the hemoclips group, which reported more single gastrointestinal angiodysplasias. Rebleeding was significantly lower in patients receiving hemoclips (34.9%) vs patients receiving argon plasma photocoagulation (51.1%; P =.03). Furthermore, the likelihood of remaining free of rebleeding was higher among the hemoclips group vs the argon plasma photocoagulation group (P =.037); this difference was not significant when the participants were divided into 3 groups (hemoclips monotherapy, argon plasma photocoagulation, or hemoclips combination therapy).

In multivariate analysis, hemoclips combined with a second modality predicted a lower possibility of rebleeding (hazard ratio 0.46; 95% CI, 0.25-0.84). A higher hemoglobin nadir at initial bleed and smaller size of gastrointestinal angiodysplasias were additional factors associated with a lower probability of rebleeding.


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The investigators suggest that hemoclips as an intervention to treat patients with gastrointestinal angiodysplasias who are receiving antithrombotics has a lower probability of rebleeding compared with argon plasma photocoagulation.

Reference

Ismail B, Alayoubi MS, Abdelwadoud M, Castro F. P0397 – Rebleeding after hemoclip versus argon plasma coagulation use for bleeding gastrointestinal angiodysplasias in patients receiving antithrombotics: a retrospective multi-center study. Poster presented at: ACG 2019 Annual Scientific Meeting; October 27, 2019; San Antonio, TX. Abstract P0397.