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

Abstract

Objectives: Evaluate clinical outcomes in transarterial embolisation (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 and September 2020 at our tertiary centre. Technical success (angiographic haemostasis following embolisation) was measured. Uni- 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−1 (p < 0.001, OR 7.35, 95% CI 3.05–17.71) and INR > 1.4 (p < 0.001, OR 4.75, 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. Conclusion: 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−1 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 periprocedural clinical outcomes.